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<br />Accu-Labs Research, Inc. CI IAIN Of CUSTODY AND SAM1IPLE TItANSMITTAI. FORM <br />4661 'Fable Mountain Dlivc GolJcn, CO 801103-1650 ALR Job p. <br />(:f03 '177.9514 PAX (303) 277-9512 <br />1 4!'J 1 I lu. 1 <br /> PLPASE PILL OUT COMPLETEI]'. Rollie Size & Reservation Page ~ of ~ _ <br /> DE SURE SAMPLE IDrr MATCI IES SAMPLE I ARI:I. Total <br /> <br />AIR <br />Ilse <br />Only <br /> <br />Dale OI <br />Collection <br /> <br />'I ime OI <br />Collection <br /> <br />Sample <br />Type <br /> <br /> <br />ample Idmdilicalirnr Number <br />Rolllcs <br />Per <br />Sample <br />~ ~ sS'7 <br />v ~ \~ ~ Analyses Requested <br />~ \ ~ (Attach Additional Pages II Necessary) <br /> o ~~ sH <br />tt S o93 <br />o y3 9 C u lJ - o`L C S <br />C,?u ~~ ~ r~ M S ~ <br />~ ~ <br />~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> - - <br />CLcnl Name <br />Clicul Conlacl <br />Pbonc ( I <br />Sanlplcr (Print Nanlcl. <br />~~.~ ~,~ <br />Sampler (SiOnalure): <br />~7/ 0 _ <br />/~/GiFs ~ <br />FAX 1I <br />Project or PWSID a: <br />Purchase Older n. <br />Invoice To: <br />rS( <br />~ ~~~ ' ~ <br />~~Z eta ~, .,~ <br />I,=~S 9,~~w1 ~ <br />J~ <br />~~~J cvJ z <br />- ~~ti~ ~~ <br />(-~~o <br />V J <br /> <br />Ry: <br />11 linqulshed Dale and Time Rec Ive Ry; <br />A/ <br />a N ~I ~h ~ ?y ~y13 <br />2) Relinquished Ry: Dale and Time Received Ry: <br /> <br />3) Rclinquislred Ry: Dale and Time Received for ALR Ry: <br /> <br />IAII RESERVES TIIE IIIGIIT TO RflU1iN UNUSEU POICFION OI~ SAMPLES '1~0 (:LIEN~f. <br />