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Page ~ of <br />'~~~ CORE LABORATORIES <br />V1b~Yern Ades <br />Internetionel <br />CHAIN OF CUSTODY RECORD <br />~~ <br />CUSTOMER INFORMATION PROJECT INFORMATION 00 <br />COMPl~NV. /~ - <br />C.N d. /J/l//SrDn IT //'IKe/~[/l~ ~ PPOJECT NAMEMUMBER:/ / 1 ~T~ <br />/D L+tiGK 7L~1~? L~IIKQ <br />N ~ ry <br />a <br />sENDREPO Pek brLvtSO BILLING INFORMATION Z ~~ / <br />ADDRESS: / +' SGT e,. ~i K / ~ <br />!j ej BILL T0: ~ ~ ~ _ ~y\~OJ ~ ~ ~~(' <br /> <br />n ~~ ~- C b ~2 c~ ~ ADDRESS p~j <br />o V <br />J LAB JOB NO. <br />~ ~ v~ <br /> W ~ <br />~ <br />07~ <br />PHONE <br />G-3s G ~ PHONE m <br />~ <br />`~ <br /> FAX: PO N0.'. _ ~ Q <br />SAJAPLE NO SAMPLE ID SAMPLE <br />DATE SAMPLE <br />TIME SAMPLE <br />MATRIX CONTAINER TYPE PRES. h REMARKS /PRECAUTIONS <br /> C ~ S-S-9 3 /b•~ /~ w, GF.S~ic l ~ lfaraod ~ I Z v~//l~G <br />Z -S~3 /U; ~ ~I /asf,~ ! ,•lf~~~P K z w /lN <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER: / eK b r" e K s o rt SHIPMENT METHOD: AIRBILL NO.: <br />REQUIRED TURNAROUND:' ^ SAME DAV ^ 24 HOURS ^ d8 HOURS ^ ]2 HOURS ^ 5 DAYS ^ 10 DAV$ ^ ROUTINE OTHER <br />1 <br />RELINQUISHED BY: DATE 2. RELINQUISHED BY' DATE 3 RELINQUISHED BV: DATE <br />. <br />SIGNATURE: SSL`3 <br />~~TT J SIGNATURE: SIGNATURE. <br />PRI TED Nl~MF1COMPANY: ~ /1 • M ! ~ // <br />rt yl'2a n yv. r4P,et~ S~1~aj TIME <br />~3i PRINTED NAME/COMPANY: TIME PRINTED NAME/COMPANY: TIME <br />1 <br />RECEIVED BV: DATE 2. RECEIVED BY: DATE 3 RECEIVED BY DATE <br />. <br />SIGNATURE: d /] 5•J~/' SIGNATURE: SIGNATURE <br />PRINTED NAMFIC A Y <br />va.,., G~ mac. L G.,rAf,r: ~s T <br />°eF7 " PRINTED NAME/COMPANY: TIME PRINTED NAME/COMPANV: TIME <br />• RUSH T RNARO D MAV REQUIRE SURCHARGE <br />^ MahMm, Ctllbmle ^ fang Bach, CtlBarnla ^ bnvar IAUmnI. Colontla ^ Cupar. Wyoming ^ Houston, bau ^ Holston, bau ^ Capw Chtlstl, Teau ^ Lab Charlu, Loulalue <br />1250 E. Gene Awry Way 3100 Cherry Avenue 1900 5. Potomac 51. - Bune 130 120 West Ist $Vee1 10201 Wesiheimai. BNp I ~A 8210 Masely Bose ^3J NMh PaOre Ielano Or 3515 Anm1a Street <br />Anaheim, Caliloms 92805 Lmp Buo1 Calilamia 9080] Mmra. Coloratlo BOOt2 Casper Wyoming 82601 Houvon, ieus P042 Hpusmn, Teas ]10]5 Coryus Chrulh Texas ]8100 Sulphur Lauisare ]0663 <br />111/1 B3]~IpBO (3101595-8101 (3031]514180 130]123&5]11 111919]26]00 1]IJ) 913~9P6 15121209-26]3 13161 5891925 <br />ORIQINAL <br />