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eacreotGr up <br />AN ENVINCNNzftr L 66RV{CED cc" EANT <br />CHAIN OF CUSTODY 500 S. Arthur Avenue, Unit 450 - Louisville, CO 8002 <br />(303) 661.9324 - FAX (303) 661.932 <br />Client/Project Name: 7" ,- <br />Analysis (Check all applicable) <br />P.Q./Project Number: <br />3 <br />coO° <br />° <br />Cl <br />°..' <br />u <br />-a <br />'C <br />0 <br />m <br />a� <br />acs <br />"o <br />Y <br />a <br />2 <br />0),., <br />a� <br />=a <br />w <br />oC <br />U <br />� <br />a <br />3 <br />O <br />m <br />N <br />� <br />N <br />\ <br />"' <br />F <br />g <br />O <br />m <br />�+ <br />v <br />;' <br />u <br />2 <br />o <br />W <br />� <br />M <br />Q) <br />LL <br />o <br />E <br />U <br />O <br />o <br />a <br />m <br />'Jr <br />47 <br />C <br />S <br />�. <br />o <br />Contact: 1c <br />Address: p andn0 <br />^w <br />Phone # j E -Mail: ,a <br />' <br />Fax # / ,1" Sampler: j <br />Report By: ❑ Mail ® PDF ❑FAX <br />¢ <br />w <br />u~i <br />¢ <br />ui <br />N <br />N <br />En <br />O <br />o <br />C <br />„ <br />` <br />o <br />< <br />s <br />> <br />« <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Lab ID <br />Com <br />amuseOW <br />° <br />a <br />c0� <br />o <br />° <br />m <br />z <br />SW <br />6-16, J <br />WOO <br />3153740t <br />6- <br />Turnl fi. pn¢ Reg a gis-1 _jest <br />- . . <br />5 ecies: Fathead Minnow <br />p ❑ <br />Certo daphnia ❑ Daphnia magna Daphnia pulex E]Other <br />(List Below) <br />- dna icahrestt '- c �s _ = <br />Standard (10 days) 6-9 Day <br />3 -5 <br />3-5 Day 1-2 Day <br />Special Instructions/Comments: 2, $ j 61 g , g I? - <br />f- '4 ea, r., .7 <br />Requested Report Date: <br />'uisTi-`e+d� <br />T ^----- -.----------.:.--•---- <br />ggnatu / <br />Date ime (�. <br />re <br />DatefrimeSignature <br />(V'�„ <br />Datefrime Signature.,,,_..., <br />Date/Time <br />