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eaC-eptGroup CHAIN OF CUSTODY 500 S. Arthur Avenue, Unit 450 - Louisville, CO 66027 <br />,,, Exv xJwwFxru ___ __ .' (303) 661.9324- FAX (303) 661.9325 <br />Client/Project Name: LIG <br />Analysis (Check all applicable) <br />P.O./Project Number: �U�i v-x-z-ot yw: <br />°' <br />a; <br />�, <br />+� <br />Q <br />w <br />o0 <br />m <br />YQ <br />O <br />t <br />v <br />W <br />o <br />v <br />v <br />N <br />Q <br />¢ <br />W <br />3 <br />o <br />o <br />v <br />LU <br />W <br />i= <br />Lu <br />3 <br />o <br />m <br />H <br />= <br />v <br />Q <br />0 <br />o <br />En <br />o <br />m <br />�+ <br />a <br />u <br />> <br />° <br />(1 <br />to <br />a) <br />=° <br />o <br />U <br />o <br />" <br />L <br />+� <br />o <br />E <br />_o <br />o <br />u <br />v <br />o <br />o <br />m <br />° <br />`� <br />a <br />o <br />c <br />E <br />z <br />E <br />to <br />o <br />f— <br />_�� <br />Contact: }� <br />Address: 7_7 1.44r W Ise_ CY-L g( A -Z-4 <br />Phone # p j U <br />E -Mail: (%R t 5th (moi G z <br />Fax # (� Li LO <br />Sampler: i I=z� <br />Report By: C] Mail ❑L -P F ❑ FAX <br />Sample Location or ID <br />Date Time <br />Grab/ <br />Comp <br />Lab ID <br />(LAS Uv! 00y) <br />N �a SOil <br />10.1% JOS-2- <br />oSzTurnaround <br />TurnaroundRequirements <br />Analytical Testing Only) <br />Test Species: `Fathead Minnow C3 erio daphnia ❑ 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 />Relinquished By (1) <br />Received By (1) <br />Relinquished By (2) <br />_ <br />Received By (2) <br />Signature <br />Date/Time <br />Signature <br />p� <br />Date/Time <br />Signature <br />\-J I <br />Date/Time <br />Signature Date/Tim'er! <br />� is Z(�l <br />dr ' "t , <br />0 4d_J <br />