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ENERGY c t Chain of Custody & Analytical Request Record / . <br /> TrWle.rheple.TruaearOsa. www.energylab.com Page / of I <br /> Account Information(BilityInformartal) Report Information(!dAlerentthan Account tMbrmatton) Comments <br /> Contact Company/Name 6 rr�" � f Com ry/Name <br /> �cf Contact <br /> Phone 516- `3 -!)83 Phone 514147fE"''' <br /> Mailing A 13( 3395 Mailing Address <br /> . <br /> City,State,Zip d i cb VP City,State,Zip <br /> Email RAI,`s� fjtij �(,0v( Email <br /> Receive Invoice• • lerd,d Copy XmaM Receive Report %lard Copy jklemail Receive Report OHard Copy DEmall <br /> Purchase Order QuoteBothe Order �: <br /> 1 /3412 '/ 0 LEVEL IV 0 NELAC D EOD/ED7(contra laboratory) 0 Other <br /> • <br /> —� <br /> Project Information L sMatrbt Codes Analysis Requested <br /> Project Name,PWSIO,Permit etc. j�.f'/64/2 D 00 A- At All turnaround times are <br /> yp� j W- Water standard unless marked as <br /> sampler Name 4,t,�fC 1 y4,/l Sampler Phone�V13-. I s. RUSH. <br /> SampleOrigin Stater-Co EPA/State Compliance Yes 0 No v. wes+ran MUSTEnbeey contacted <br /> Laboratories <br /> i <br /> rip ' � contacted prior to <br /> 'URANIUM MINING CLIENTS MUST Indkaw sample type. B- atameay m RUSH sample submittal for <br /> 0 NOT Source or Byproduct Materiel G- Ottier = dlatpes and scheduling Ing- <br /> o SouroelPmRefried)cesaed Ore(Ground or ."'CALL BEFORE SENDING DW- , A See Instructions Page <br /> O 1 le.(2)Byproduct Material(Can ONLY be Submitted to ELI Casper Location) «<4 <br /> r Sample Identification Collection rummy ie Matrix Va' <br /> (Mom Location, 440Date Time Contac' r300 Clo* '69Abe TAT �'"'# iMY1._ .'=:k <br /> 1 i3, 4ilia Offs' i - 2.00zogitbq.4.01 <br /> i3 P-8 3 13 DQs�f I _ - ► <br /> 3 <br /> 4 <br /> 5 <br /> B <br /> 7 <br /> 8 <br /> 9 <br /> 1a <br /> Cattftely Received M(t.b r aMrrim�t 9lprature <br /> R ST ,i 4s. 1 : t -f =:' t <br /> 2.1 <br /> be dated Rallrqubhsd by(print) o.at inn. alpnMue i;°tw Tt+rrTiTr OW:ii•1 : ` 1-. +1• 7f <br /> cc <br /> � .� �, -=• ;ijzi• ' i.:;c...::r� :•;fir,,rT74i7•i;.'. ;;r._: ;:', .�.. . . :L:�._.e�__ .. a�' r t -, • . .: l•-==!. -::rc.' ::•...::� ,- .,_. <br /> o ShipQedBy Cooler ID(s) <br /> Custody Seals Intact Receipt Temp Temp Blar* On Ice Payment Type Amount Receipt Number(c.art,eck oai5) <br /> co Y NCS YN °C Y N Y N CC Cash Check $ <br /> . -- ---- in-sertein circumstances,samples sub maed1oEnergy.Labotatories,inc.may be subcontracted loathes certified.)abcratQries in order to complete the analysis requested. <br /> Thie camas as rsntina of this nnedhlhty All subcontracted data will be clearly notated on your analytical report. t:tl-toa10/i8 v.s' <br />