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<br /> <br />Iv <br />7 <br />F <br />•,~ <br />' GORE LABORATORIES <br />Irt~tAnwr ce~l Analysis Request and Chain of Custody Record <br />"~"~r^ 1300 S. POTOMAC. SUITE 730 <br /> AURORA, CO 80012 13031 751 -1780 <br />Project No. Client/Project Name Project Lceation <br />Lab <br /> <br />ID Field <br /> <br />Semple No. Date <br /> <br />antl <br /> <br />m n <br /> <br />o Sample <br /> <br />Container Sample <br /> <br />TYPe (Liquid <br /> <br />Praser- <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br />REMARKS <br />No. Identification Tima t7 U (Size/Mat'll Sludge, Etc.) votive ~ APPU E, ~ AI.L ~pL[,D u,-37~~ <br /> CP Y <br />5' X 1 L Pc W~rt/L_ i.{rtoN CN ~ %t7; ~L, wn+~~ <br />'~ t- <br /> 3 <br /> So0r.~1 PE f{rJ0 Zrac~ i/lorJ~ cac.crurt.l ~ Soptu..t <br />r_oppul 1j <br /> 3 / <br /> <br /> CAp 9/~ ~ X 1 L P~ ~At ` NCH <br />t- <br /> Sat,,.t l c Nr~3 1) <br /> <br /> <br />~-L. 9i3/qa <br />IS3o <br />>< 1 L. PE <br />5tw+.r-PE <br />WRT~1L <br />N.ON <br />~-LS_I' <br /> $t9Jr.l PE F}No3 / 7 <br /> <br /> <br />Semplarr: ISipnaturo/ Ralinquirhetl by: Date : 9~y~9~ Received bY: Oata: COC Sael No. <br /> <br />2. ISiynarurol 2. !5~ <br />Tima• (Sipneturo) <br />Time- <br /> flalinquirhetl by: Date : Rataivetl by: Date: <br />AHllFatlon I~Ppeturol Time: (3rYrraNrol Tims: <br />/-}AVJiy, s[/7 ~ /{ ~SeC Ralinquirhetl by: Date : Renivetl by a Dataf~z. - Intact: <br /> lSiynaturol <br />Time: ISiprarurol <br />Time: J ,.rC.! <br />REMARKS: Date Rar tr To: IN /Atldreul Laboratory No. <br /> <br />C' ,. ~i~aaa Sao!-+ - B•uG <br />FaY (Lf_Sur_rs ~ f/ac.EPAStcR %, ASSoc_ <br />19H'3~ W5~ oa I (D~~ <br /> 2. R+9cF iaPOfJL _ rl ti ~4 <br />White - Rsturn With Rarultr Of gnalyris Yellow -Lab Copy Pink -Sampler Copy <br />