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TRE Environmental Strategies, LLC Page I of�_ <br />100 Racquette Drive, Unit A Fort Collins, CO 80524 Phone: (970) 416-0916• Fax: (970) 490-2963 <br />Client/Project Name: yr .. —wr <br />Project 011 aZ <br />Test Requested <br />a <br />a <br />G <br />Q w <br />ss <br />a € <br />C <br />m <br />o. <br />n <br />Sampler (Print/Afflliation):/47 Signature: <br />c <br />Chain of Custody Tape #: 4C3(,sr Intact?(cirde): s No <br />• �. ;f�•?r:�y^:�,:�t':3:: ::?�t�'°i�:C,Fc,; ._ut'�n:v ea'1''�.• r.�.'.'o-1t„.` <br />Sample Collection Sample Ty <br />Client Sample ID B <br />/ p Beginning Ending a <br />Date TimeDateDate Time <br />Volume <br />Preservation <br />28-15 Si 5 f, <br />7-,V-15 8174 <br />X( <br />a_s wj <br />0 L <br />-L-- <br />�•3 <br />r� <br />Sample Relinquished By: (Prot Name/Afflliatian) <br />Date: 9-20—Zm5 <br />Time: /J. 3o A <br />Date: <br />Time: <br />Date: <br />Time: <br />Received By: (Prot N,,,wAter,twn) <br />Date: A -ZoA CS <br />Time: tS, u <br />Date: <br />Time: <br />Date: <br />Time: <br />Laboratory (Destination): <br />TRE Environmental Strategies, LLC <br />100 Racquette Drive, Unit A <br />Fort Collins, CO 80524 <br />(970),416-0916 <br />(970) 490-2963 (FAX) <br />Signa ure: <br />Signa e: <br />Sample Relinquished By: hint Name/Atma k n) <br />Received By: (Print w rngAfnww) <br />Signature: <br />Signature: <br />Sample Relinquished By: (Print Name/AFRianon) <br />! <br />Received By: (Print NameJAHMatlon) <br />Sample Shipped Via (drde): <br />FedEx Other <br />UP Courier <br />Temp Blank? <br />Yes <br />Signature: <br />Signature: <br />Comments: <br />Q � - 7. (oA <br />6 <br />Serial No. 00759 <br />