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TestAme-- -, Denver Chain of Custody cord _ <br /> may <br /> 4955 Yarrow Chain .G <br /> Arvada, CO8uu02 <br /> '.�, <br /> Phone(303)736-0100 Fax(303)431-7171 :iir renrn,•i r vvlanaxrry +r-.*ur <br /> Sampler Lab PM Carrier Tracking No(s) CDC No <br /> Client information SKIS lHarrington,Danielle M 280-66800-22620 1 <br /> Client Contact Phone E•Matl Page ¢. <br /> Paul Kos danlelle harnnglon@testamericalnc.com Page t l O <br /> Company Job# <br /> Norwest Corporation Analysis Requested <br /> Address Due Date Requested: Preservation Codes: <br /> 950 South Cherry Street Suite 800 <br /> A-HCL td-Hexane <br /> City TAT Requested(days): 8-NaOH N-None <br /> Denver C-Zn Acetate 0-AsNa02 <br /> Stale-Zip (= D-N4nc Arid P-Na204S <br /> CO,80246 E-NatiSO4 0-Na2503 <br /> Phone Poll ± F « F-McOH R-Na2S203 <br /> cared w= a G-Amchlor s-H2sD4 <br /> Purchase Order not required <br /> I <br /> mH-Ancoroc Acid T-TSP Dodeahydrate <br /> Email WO# sI-Ice U-Acetone <br /> pkOs@nonveslcorp-CoinJ-DI Water V-MCAA <br /> Protect Name- Pro(ocl# K-EDTA W-pH4-5 <br /> L-EDA Z-olher(specdy) <br /> Colorado Springs Transit 28013507 N i aSite -� SSOW# N 's 9 ,+ Other: <br /> JMatrix E <br /> (w'«+ . JEEN 4 n iS•.olltl, r �Sample (C=Comp o-.,awwl.Sam le Identification Sam le Date Time Ca-- rab eT=T,..,,..A-Aii R c N � Special Instructions/Note: <br /> c0) Preservation Code: X>QD <br /> �[ N�( N D N/ <br /> 01 LI �67 �t �S-f7-(7 «d L WalorC.n <br /> C_ 14 1 1 Cs ZO ( Water x J X X Login Shortholds include pH.1C nitrate.IC <br /> nitrite <br /> LrI <br /> v cx3L) 6 Water X h X x <br /> LTC- 6�,W- 3 C 14 3 1100 I L Water n X X <br /> LTC.- C-7 3 C N 7 1 1 L40 L Water K x x <br /> C.14 1. l q y0 C"� Water X �( vx <br /> L'rG w- L C_f4 1 280-100439 Chain Custody <br /> I�.J - C'1�! � 16� c:. vy )( X X •� <br /> X1 X <br /> `-1 H 5- 0:1 Flo Ix X x x <br /> LTA-�,W- �I GN �• �-►tS_( G`1So G 1.� x X X � <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 1=Non-Hazard Flammable Skin Irritant Poison B Unknown =Radiological Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,11,III,IV,Other(specify) Special InstructlonslOC Requirements: <br /> Empty Kit Relinquish Date: Time Method of Shipment, <br /> R,Kqwshed by Ir Company Recetxed by Dater rime om an <br /> r <br /> O Relinquished by Date/Time Company Reeewed by DalerTime Company <br /> OD <br /> Relinquished by Dole(Time Company Recorved by Dalr{Timr Company <br /> N <br /> O <br /> -� Custody Seals Intact Custody Seal No.' emperanre(s)°C an Other Remarks cooler T �y <br /> Yes A No Zi 3 -2 `fV -1 <br /> i>u <br />