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TestA ca Denver <br /> 4955Yarru-. treet Chain of Custody record TestAm .- _:a <br /> Arvada," CO 80002 <br /> THE <br /> Phone(303)736-0100 Fax(303)431-7171THE L<a :ti EVwrrcrnrir TESTING <br /> Sampler ` , '� Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information W��J', Harrington,Danielle M 280-43276-16771.1 <br /> Client Contact Yt Phone: J E-Mail: Page: <br /> �� �� l.D(Ito danielle.harrngton@testamedcainc.com Page 1 of 1 <br /> Company- Job#. <br /> Norwest Corporation Analysis Requested <br /> Address: Due Date Requested: -)' Preservation Codes: <br /> 950 South Cherry Street Suite 800 x <br /> City: AT Requested(days): ;;, < B-NaOH N-None <br /> ne <br /> Denver t-: C-Zn Acetate O-AsNaO2 <br /> state <br /> O,80246 �# w 280-70820 Chain of Custody G-� d S-�H2S�O3 <br /> Plone/�� Purchase Order Requested F H-Ascorbic Acid T-TSPDodecahydrate <br /> Email: _ �R WO* N .�+ I-Ice u-Acetone <br /> �n�.� f J-DI water V-MCM <br /> ZE1 K-EDTA W-ph4-5 <br /> Project Name: Project#: >- n L-EDA Z-other(specify) <br /> Transit Mix ASK D Harrington for Project Number S" <br /> Site: SSOW# Other: <br /> Colorado u o <br /> o <br /> Sample Matrix a m <br /> Type (vv=..e., 0 t Z = z. <br /> _ 0 8 v <br /> Sample Identification Sample Date Sample <br /> G=g by ern aar M a F $ Special Instructions/Note: <br /> y <br /> N Pri�aWf'Co�de-' <br /> N .'�'. : D N ti d d 0 NO3 <br /> (D LTc —� ' :�� Water X Short Holds 'n u e: pH,Cr6,300. <br /> N ��and NO2 <br /> O <br /> N <br /> k� <br /> Possible Hazard Identification j Sample Disposal(A fee maxyb��assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard =Flammable Skin Irritant =Poison 8�"'�'Unknown =Radiol ical EDRetum To Client �'�[Dis osal By Lab Archive For Months <br /> Deliverable Requested:1,II,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date: I Time: Method of shipment <br /> Relinquished by. DateTime: f ny Received ime: Compare <br /> rn � Fi /S /c <br /> W Relinquished by DateTm. Comparry Received by. Da me: Company, <br /> O <br /> N <br /> O Relinquished by. DataMme: Company Received by. Oaternme: Company <br /> Custody Seals Intact Custody Seal No.: T peratur "c a Omer Remarks: t <br /> 0 Yes o No <br />