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CHAIN OF CUSTODY 1341 Cannon Street - Louisville, CO 80027 <br />�eacre7,r . .oua (303) 661.9324 - FAX (303) 661.9325 <br />..- ......... ... .... <br />Client/Project Name". IA/z5f -j2 f a ?,1 1, <br />Analysis (Check all applicable) <br />P.O./Project Number: ./ViLW Hvri�o, Alivi, <br />0 <br />v m N <br />U <br />2! <br />< <br />LU <br />co <br />f6 <br />-0 <br />0 <br />U <br />0 <br />a C <br />-:3 <br />< <br />M <br />C <br />W <br />CL <br />y7 <br />03 <br />-C' <br />U <br />ZA <br />-2 <br />.5 <br />3 <br />a <br />0 <br />i <br />> <br />E <br />E <br />2 <br />U <br />-0 <br />. <br />0 <br />y <br />t0 <br />0) <br />E <br />U <br />0 <br />co 1 <br />0 <br />ca <br /><' <br />W <br />J2 <br />E <br />0 <br />z <br />Qj <br />0 <br />> <br />- <br />M <br />Contact: T6m Fr) <br />Address: 2-76 4 Avie. A'gatj, 64) <br />Phone #C(7 0 14, /-f -7 ;-q <br />E-Mail: T FrX 40 Wj:7(-,Vqda. <br />Fax#q7U �,'64 -2i �- <br />Sampler: T. Ra.94a)-,,— <br />Report By: ❑ Mail �TPDF ❑ FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />comp <br />Lab ID <br />/Y PD C 12612 <br />7.24 - <br />t 67 0 6) <br />Test Species: Fathead Minn.. Z=iodap hnia ❑ <br />Ef <br />Daphnia magna ❑ Daphnia pulex ❑Other (List Below) <br />Standard (10 days) 6-9 Day <br />3-5 Day 1-2 Day <br />Requested Report Date: <br />Special Instructions/Comments: <br />R <br />14 <br />Signature , re <br />Datel me <br />-7. <br />S <br />ate/rime <br />Signature <br />Date/Time <br />Signature <br />te/rme <br />