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N° 10872 <br />~b <br />'~,' <br />CORE LA60RAT ORIES <br />t ~r v o„'I Analysis Request and Chain of Custody Record ' <br />""'°'~"~ 1300 S. POTOMAC, SUITE 230 <br />AURORA, CO 80022 13D3) 751 -1780 <br />Project No. Client/Project Name Project Location <br />Sa8 ti P~Arj>.~ M rnI . G~~ Sr9rJ LU I S <br />Leh <br />ID Field <br />Sample No. Dete <br />end <br />m n <br />E <br />V Sample <br />Container <br />' Sample <br />T <br />yp ~I Liquitl <br />Preser- <br />vative <br /> <br />ANAL <br />Y <br />S <br />IS RC~EST~D <br />. <br />- <br />^ <br />LABORATORY <br />REMARKS <br /> <br />No. <br />Itlentiiicetion <br />Time <br />(7 <br />(Site/Met <br />ll <br />Slud e, Etc.) <br />~ t <br />~ <br />L- <br />f <br />~~ <br />~ 2 /iCrl.$tv[.- uS <br />~l31~ <br /> <br />" 4/N/q~ Ca <br />~ <br /> + <br />tS-S oq/5 X Soo,wl PE WA%E/L N/JO3 jail9L <br />~., ~tS~t~c.d Me,-{.alS <br />t ~; /Y <br /> ~a ~ <br />~ ~ Pc <br />I{ao <br />2a~;~cNe-M n <br /> SmMI PE Z,.)Ac Sut_F~D~ h ~''~~" <br /> 1 L GI N:Soy OtL 4- G2fASE. n) <br /> -,reoe,l GI 64ZSoy i0C n1M3 / n103 tn-)Oa )/ <br /> <br /> 1 ~ Pt n~+E n~ASo2 A~ ro,a g In ~ F: ~ f <br /> 1 L P~ /faOH Cnl ~ 7Di A(. WAP, ~'' / f <br /> <br /> <br /> <br /> <br />Samplers: lSipneruro) Relinquished by: Date: 9 y/Orb Received by: Data: COC Seal No. <br />~ <br />Q , 1 (Sipnerurol 2 <br />Time: !(3D6 (Sipneturel <br />Time: <br /> Relinquished by: Date: Received by: Data: <br />AttHietion (Sipn~turol <br />Time: (Sipnerursl <br />Time: <br />-iflLrp~KA t.` qa>~q- Relinquished by: Date: R.nived by o et ry <br />! Date: ntect: <br /> lSipnerurol <br />Time: (Sipnerurol <br />~l <br />Time: OV <br />REMARKS: Data Re is To: IN s/AtldrsY) Laboratory No. <br />is <br />(l <br />S -lA <br />~ <br />' (7`ty -3~~15~ <br />A ,. ,qu,.,A ~co r~ - /~.tG <br />uLSS <br />.~ <br />~A-K ~ <br />tt <br />issrcq <br />• ~oc.. <br /> . <br /> <br />White -Return With Results OI Analysis Yellow - Leb Copy Pink - Semplss Copy <br />