Laserfiche WebLink
II NI II~ e D <br />~~ 0 <br />0 <br />i <br />v <br />z <br />a <br />a <br />z <br />N <br /> <br />CORE LABORATORIES, INC. ND• 1,i ~ 4'b <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMA710N PROJECT INFORMATION p <br />O <br />COMPANY: /+ , <br />~3oL~rGe G 1e 2. LAAC.. PROJECT NAMEMIIABER: <br />w/an S~SS~ ~.Z` <br />~ <br />SEND REPORT i0' r <br />~ow/ /aa,.r.t3er <br />BILLING INFORMATION <br />Z <br />~~ Xd <br />ADDRESS: Blll T0: F y~yOJ <br />C I i s ,.,'., <br />e era o 3 CO ADDRESS ~ Q" Q <br />2 LAB JOB NO <br /> <br />>nlo~o3 <br />~ <br />~ \ . <br /> <br />9 <br />PHONE: <br />7/9- G 3s- ozz9 PNONE: m ~ 4 aYS~ <br />FAX: FA%~ Pp NO : Z <br /> <br />sAM4LE NO. <br />SAMPLE 06t6iIPTlaN SAMPLE <br />~ DATE SAAPLE <br />TIME SAMPLE <br />MATRI% <br />(DNTAIrfR <br />PRESERV. <br />REMARKS /PRECAUTIONS <br /> <br /> <br />n~ w- Itt W - 7 " /y, z,s Ft X <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER: SHIPMENT METHOD <br />U. S AIF10111. NO.: <br />!Z <br />~Xo (odo oQ ois 7y~7 <br />PEOUIREO TURNARWND:e ~ SAME DAY I I TI HOURS <br />1. RElINOUISHEO BY: <br />SIGNANRE: ~Y /~ I` 18 HOURS <br />DATE <br />n/,/~~ <br />Y I ~ TP NOURS ~ DAYS ~ 10 DAYS <br />2. RELINCIASHED BY. <br />SIGNATURE: i ROUTINE OTHER <br />DATE 7. RELINOU6lED BY: <br />SIGNATURE: <br />DATE <br />PRIIITED NAM ANY. /Y <br />CSRVVtCG ITC~~'c(!Cc /,yG TIMf~ <br />~~//~~ <br />~f•~l.l/ PRINTED NAMEICCMPANY: TIME PRINTED NAMEICOMPN/Y'. 71ME <br />1. RECEIVED BY: GATE 2. RECEIVED BY. DATE 7. RECEIVED BY:' DATE <br />SIGNATURE: <br />~:.~ 15.;9 <br />9- SIGNATURE. $IGNATIAE: <br />PRINTEDNAMEIC Y~: -' ///,~E ~~ T~~IO PRINTED NMIFICOIAPNIY: TIME PRINTED NAMELOMPNIY: TIME <br />^ ANnr~ u <br />I]SO E.(arF.my NY/ <br />MWrrl G 4F6f <br />Pul e]3neo.1 Fr Pul ali.uro <br />^ Ilelrbn. Tl[IE•.1 <br />alto rorr+r ow <br />Hanv~. TIl1)010 <br />plal4a.... f•. al]I sneeze <br />~Awam <br />IOA] E bfr~ Piw <br />MFVL CP YOI• <br />Pvl3el ~lA) FU (1~ ]SI ~I iM <br />T] Ils~vt, T1f IF.9 <br />410 Yerry Potl <br />tYr~r. TM T03 <br />Otg11NNne Fu Ppl o.1]eM <br />^ l+~rr.G <br />]13.L5 NWrga. Ma . Sre 301 <br />fiv.GAN161W <br />Plq SI]-All Fu Ptq 511]313 <br />O Inru~t]la w <br />1TSIIAf~INFO <br />Infr~~ iL III.® <br />PIT anew Fs. Pt31 e4atlp <br />O VF~.n <br />•]OW F.r euFl <br />figw. tH' C.90t <br />P0~ 3]s5).1 Fu Pe313eate39 <br />O W. MYaG <br />.E.S b~ Pr.~ry <br />sw. u 3m4 <br />ptq e4.ae fu plq e4+49 <br />O vp.. a.rF.n <br />tTD X. PYF Wtl qrn <br />Grgp ~. ill )MO! <br />61313®wl] Fu ryla iea].il <br />O rFp~FIF~r <br />3~ GnsIN Prn <br />vaP.~o.v.lml <br />Pt]I •u.~fe Ptq.439U <br />O rrwt.lu <br />TF F.nM CNNr Parn.M <br />Fa.m. w u43 <br />(» 33521W Fa (1]31335CR1 <br />