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N" ~1U421 <br /> <br />~~, <br />' CORE LABORATORIES i <br />~~etJo ;i Analysis Request and Chain of Custody Record , <br />"~'°~~^ 1300 S. POTO MAC, SUITE 130 <br /> AURORA, CO 80012 (303)751-1780 <br />Project No. ClientlProject Name Project Location <br />sa~ti ~q++-~ M~rJ . CoL,/,> S,or.l Lul g <br />co <br /> , <br />Leb Field Date o. Sample Sample <br />ID Semple Na, end m E Container Type (Liquid Preser- <br />ANALYSIS REQUESTED LABORATORY <br /> <br />No. <br />Identification <br />Time <br />(~ <br />U <br />(Size/Mat'll <br />Sludge, Etc.l vative <br />~L AvJ^L SIS <br />ALY/s,JC~ TO fit,(„ 5,1M/{,~/S REMAfl KS <br /> <br />PItF-OE:oX s0/i~IQ? <br />t'13o <br />/ <br />1 t_ P~. <br />wArE2 <br />r1goH <br />C.J C <br />FbTAt_ r wnp, <br /> SaO r..t PE Nr~03 Cu <br />Zra AQ^r/ N: <br />N a <br />Fe, <br />Ca <br /> t <br />r / <br />r <br />/ <br /> <br />('oS~-DET'ox /o r~ <br />~ <br />S <br /> +000 ' Ar3e~t WAft<fL 5A^u. AS A30sK. <br />~~ I ~-u ^^'`~ A-S <br />. o930 /i3o~c r,JAT[/Z- S A3o~-C. <br /> <br />'~- L to/tS/99 <br />r']/o <br />`~ SAn,< ag <br />/+~ouc <br />wAr"E2 <br />Srt^u- <br />A S /0/3os/C- <br /> <br />C <br />P 10/r5/9d / S~Mt- AS <br /> . /~3o A3oyti WA~1L_ SAµt. As A3o/c., <br />•~ CPt-~ to/tS/Ra ~ goa.~ A S <br />' <br />- <br />S <br />A <br /> s8oo A3b..t L~ns <br />Y> <br />L. $Arw.t.- • <br />ABOt/'C. <br /> <br />11 <br />3~a~ ro/IS/9? <br />~ $o.+c AS <br /> /000 ,agavt taak/L, SA Mt /1-$ AFjoJ-e_- <br /> <br /> /O.bi•q~ <br />Samplers: /Signerurol Relinquished by: Date : /U/(b /~ a Received by: Date: COC Seal No. <br /> <br />2, io <br />js-Z~ (Signature) ~ <br />\O _~ <br />Time: /y4C9 lSigneturel <br />Time: <br /> Rellnquished by: Dale : Received hy: Date: <br />Affiliation fSiBneturel <br />Time: lSigneturel <br />Time: <br />b!A(~q~>s(q •~ /;yse~„ Relinquished by: Date : Received by Laboratory: Date:)~,t b-Q r~,sct: <br /> /Signature) <br />Time: /Signature) t <br />,s 7l <br />Time: I s•{ '.61 <br />REMARKS: Data Rewl[s To: (Neme(Addressl Laboratory No. <br /> 1. At.gr.fp SCoti - 3MG <br />~X 2fsu L~ S vo /{Ar~pAStcA ti flascr 74~/-3~yS <br /> .. <br /> <br />While -Return With Results Of Analysis Yellow -Lab Copy Pink -Samples Copy <br />