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E RG Chain of Custody & Analytical Request Record <br /> NertesIrseel.,itielmars. www.ep''yrtab.com • Page of <br /> Account information amswinromwsx0 Report Information Of Warrent Oen Account hMbrmetlarr) Comments <br /> CmPw101.nleC )5GA,LN ZiVallaeei Con Na " • <br /> c°11tact 11141 eli1771 Contact <br /> . '4#4,/t/f6° <br /> Phone Si 14-62.7 Phone - IL \°°(.17'r-.) -Nfl-VM * <br /> Melling Address aog 35 . using maw. ,loyi <br /> ,,. cr-- 1,4 4,c <br /> .m JU6bektro►�,co Cay G .� E� 0 ' t�'' \i <br /> Receive <br /> Receive I Emig wb Cam el 'Recon.Report d Capy ll Reinke Repot lard Cay*mei , n\,,,{` r 7`z <br /> Pushers orderrudeI 39Y71 tarrEt.Nspicier VO NSC CI EDDIEOrT h t rem Cil Other <br /> 1� <br /> Project Information Matrix Codes Analysis Rruested <br /> times are <br /> Project Herne,PWSD.Permit,dirk CPEAS�c, 01 w-WAIN standard unless marked as <br /> )�/ /,�,, g�y� 1 � J s_ RUSH. <br /> SeetpirrtWnre 1'"�gRYeS �I f j�rt`{M/ PIIa1M7�'fJL7".J` W Soils <br /> Y- Weiew EnergyLabOndDries <br /> San*/Odain Mete Co EPAl8tnte Compliance Jess O Wo s- ero..eeyMUST be contacted prior to <br /> I RUSH sample submittal for <br /> MININGCLIENTS, <br /> pimps inmate uncle um. 0-cam i U and scheduling- <br /> If ore Ibu n naeeeed a.Na.d oMrbuiis.un&iO ow- I Page <br /> o Byproduct 11(e)2=Wed Cl Unprocessed tie INOT ground or mined) <br /> Sample <br /> Loodbr►�n Date TIn1e a01�' We TAT '}' t , " .-41,' <br /> t I 07415 .)'itts _ - - 8"260 , <br /> 3 lee 3 - it ii - _ <br /> 4 J6.gf ] 41 II _ _ ._S l�. it t` It _ - _ <br /> a LJ Al I- 11 it <br /> - - . <br /> ' GL 11 tt - - _ - <br /> a 4 L !2 t` it _ _ . . _ . . <br /> 9 _ _ <br /> 10 - - -' - <br /> Custody .,_,,,i.„ , _ i Rereuve to pub Cehrlene 8lparene <br /> Record MUST I✓ 1 - 1s ; FO:-, <br /> ■� <br /> A be signed �teingtllWMdbltaa "I". <br /> rourr /411111111.1111 ♦/1 iiia FO:� 1i/1�r� ��.'fiS�ilir ' <br /> .(' . 11 e'" 9' .r•.k.. :.f Ler' sd f,....n ii._. yr'- - 2r .1�t�r .,,qt ..1 . } � Ir '.'....,. , <br /> c shipped By l(s Custody Seale u Into Receipt eO YN m -TSP On ice <br /> N CC Cash Check $ Receipt*acerber r iew.bh.ae onry) <br /> Li <br /> In certain circumstances.samples submitted to Energy Laboratories.Inc.may be subcontracted to other oertilisd iaboatodee hi order to complete the analysis requested. <br /> This sows as noticed this possibility.AN subcontracted data will be diary notated on your analytical repo& axoc.wie v.s <br />