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- T%�A 3 Denver <br /> 4955Yam,,.-.eet Chain of Custody Record TestAmc,- . ...;a <br /> Arvada, CO 80002 <br /> THE LEADER ilk EM,AROnMENTAt TESTY e <br /> Phone(303)736-0100,Fax(303)431-7171 <br /> I Sampler, Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information w Harrington,Danielle M 280-43276-16771.1 <br /> Client Contact ft I „Q - Phon E-Mail: Page: <br /> _�\ �i ' danielle.harrington@testamedcainc.com Page 1 of 1 <br /> Company. Job <br /> Norwest Corporation I Analysis Requested <br /> Address I Due Date Requested: - Preservation Codes: <br /> 9W South Cherry Street Suite 800 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Denver C-Zn Acetate O-AsNaO2 <br /> State,Zip: <br /> !' D-Nitric Acid P-Na204S <br /> 5 E-NaHSO4 Q-Na2S03 <br /> CO,80246 F-McOH R-Na2S2S03 <br /> Phone: PO P co7� C (p Purchase Order Requested 1?3a <br /> 280-73470 Chain of Custody H-a s�tc Add T-TSP Dodecahydrate <br /> Ernalt I O#: u~i " 1-Ice u-Acetone <br /> ���• },+� ,i-Di water V-MCAA <br /> Project Name: Project#: _ K-EDTA W-ph 4-6 <br /> n L-EDA Z-other(specify) <br /> Transit Mix I ASK D Harrington for Project Number <br /> site- SSOW# rq other: <br /> Colorado b <br /> Sample Matrix : a <br /> Type (vv-�.e., 0 0 Z x• <br /> Sample (C=comp, n° _ <br /> Sample Identificatio Sample Date Time G— rab aryr`. A u. a Special Instructions/Note: <br /> N <br /> aiv wuMtw^�.- 3 <br /> (D �"'� L (i 3� Water Short Holds hnd d u e: pH,Cr6, 00.0 NO3 <br /> N and NO2 <br /> W N. <br /> O_ <br /> N <br /> i. <br /> �y <br /> i rJ... <br /> Possible Hazard IderiUHcedon Sample Disposal(A fee may b ssessed if samples are retained longer than 1 monSt) <br /> Non-Hazard Flammable Skin Irritant Poison B Unknown =Radiological �Retum To went Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> Relinquished by. Date/llrrie: 1 ,� + ampany Received b. Datelf <br /> � I / s <br /> Relinquished by Date/T . Company Received by DaterTtrne. Company . <br /> N <br /> N <br /> CD Relinquished by. Daterrme: Company Received by. DatarT'rtne: Company <br /> En <br /> Custody Seals Intac,h: Custody Seal No.: Coder Temperature(s)°C and Other Remarks: <br /> A Yes A No i <br />