Laserfiche WebLink
N° 10868 <br />'~~~ CODE LABOFlATORIES <br />mAn~., <br />"~'°'~`^ 13005. POTOMAC, SUITE 130 <br />AURORA, C080012 (3031751.1780 <br />Analysis Request and Chain of Custody Record ~ <br />Project No. <br />Sa$y ClientJProject Name <br />3AT'2E Mi..l <br />GoLp - <br />$ArJ c.uls Project Location <br />.S.AnJ LUIS <br />Lab <br />ID <br /> <br />No. Fieltl <br />Sample No. <br /> <br />Identification Date <br />end <br /> <br />Time <br />o <br /> <br />r7 n <br />E <br /> <br />U Sample <br />Container <br /> <br />ISi:el Mat'll Sample <br />Type (Liquitl <br /> <br />Sludge, Etc.l <br />Praser- <br />votive <br /> <br />ANALYSIS REQUESTED <br />~ SEE TA/~L£ f Fog ~MAQf HfNSl s/E Lr$i <br />LABORATORY <br />REMARKS <br /> M-9 9~~/9a <br />16 /o X 5op.nt P~, warEfL <br />Haoy <br />Dtsxt.red M6+atg <br />7(' I) , <br /> (1~ <br />i L Pc <br />MrJo <br />2AD2o c,~c~.,~ <br />? ~Sx,,,~.,I f'. )! <br /> Seb..rl Pc Zr~Ac .SuLF.DE ~~~.~~- <br /> it_ 61 H15oy ot~ ~: 6rLEa3E /1 <br /> StoMt Gt N~So Toc, NHS / No3 { nlo~ )1 <br /> i L P~ rro,JE /I}AJ o 2 A,•I ~ oa S h /; ~~" <br /> iL Pf iJ~oH CN C7orAL, wkD~ ~~~('~~.~ <br /> <br /> <br /> <br />Samplen: lSiOnaturo/ Relinquished bV: Date: c/ a Received bY: Dsta: COC Seel No. <br /> <br />2 O (S;yn.tr,ro, 2. <br />Time: ~ duo (siyn.turol <br />Time: <br /> Relinquished by: Date: Recarvsd by: Dsta: <br />Affiliation (Sspweturol Time: (~Pruturol Time: <br />NAf.EPaSrls ~r A91oL Relinquished by: Date: Received by rato ~ s ( <br />L <br />/ D.m: 9, y_4~nrecr: <br /> (Sipnaturo) Time: lSipnaturol '1 <br />.7Y <br />L' Time: <br />REMARKS: <br /> <br />FAX /1ESu a^S To <br /> <br />/fAl.~/iaSWJ :~ <br /> <br />ASSoc <br />3?v5 <br />~ 79N -l33s~ Date Result To: lNa a/Addraaal <br /> <br />1• /~lJ1NA SecS'r - I~ Laboratory No. <br /> z. Z4 LF ibPPE2 - ff '~ /1 9t~ l 19~~ <br />Whits -Return With Results OI Analysis Yellow - Ub Copy Pink -Samples Copy <br />