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rat m mb CZ nNow <br /> OfCCHAIN USTODY RECORD � �& 7 _�� � 010 ��... ��� _ �8 �]! <br /> RESULTS TO: BILL TO: <br /> Laboratories, Inc. DAO in ��'^l'�=�E2 <br /> 5�e <br /> 30400 Downhill Drive S IZ k 1 5-3 11 •,Je- nt -r- <br /> Steamboat <br /> Steamboat Springs CO 80487 1 S 3 j I Nr 14W 01-0 L-) 91'eY05-2 <br /> (303) 879-6590 (800) 334-5493 Attn: vii Ul 1 L Tel c; -7Z /Attn: Tel: 7a- -de/-2.z. <br /> PROJECT or P.Q. # U) ANALYSES REQUESTED <br /> 3Z5754, Z.Z - Z- 4- w <br /> - z � Q <br /> NIN <br /> SAMPLERS: (Signature/Print Name) _j REMARKS <br /> ` c Z <br /> 0 <br /> SAMPLE IDENTIFICATION DATE TIME NiATR�X O o° <br /> 3s <br /> SIZK -m wl L��a` �1 I° w4N 4-' z I <br /> METHOD OF SHIPMENT: FED X UPS HAND OTHER COMMENTS ��� <br /> SAMPLE DISPOSAL OPTIONS -Please complete section A, or choose one option from sections B AND C. I F X 0)b L ' 0. s <br /> Proper char s w►71 be assessed /f © ite� IJ! UL 6.0 Z. �1'1j ' <br /> IA) Long-term storage Ia) Sample is Non-Hazardous IC) If Sample is Hazardous <br /> Hold until (date) 1) Local Disposal 1) RCRA-Permitted Facility <br /> for future analysis. 2) RCRA-Permitted Facility 2) Return to Client <br /> 3 Return to Client 1 11 <br /> RELINQUISHED BY: (SIGNATURE) DATE TIME RECEIVED BY: (SIGNATURE) DATE TIME PAGE r <br /> SAMELF-S RECEIVED IN OF <br /> GOOD CON01T10W I __�__ _ <br /> White •Return w/sample Yellow - Return w/sample Pink- Return wlsample oll �Cp. -/ GOLD-keep for your records <br />