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N° 1U~i l4 <br />1 <br />a <br />3 <br /> <br />~ ' <br /> <br />' CORE LABORATORIES <br />. <br />fnwter,";"T Or~I Analysis Request and Chain of Custody Record ~ <br />"-'°~"'^ 1300 5. POTOMAC, SUITE 130 <br /> AURORA, CO 80017 1303) 751-1760 <br />Project No. Client/Project Name Project Location <br />5,10 4 ~A'~Tlf M T~ . Cno LIB S9rJ Lla l ~j <br />Lab <br />ID Freltl <br />Semple No. Date <br />and <br />e n <br />E Semple <br />Container Semple <br />Type ILiquitl <br />Preser~ <br />si <br />e <br /> <br />ANALYSIS REDUESTED <br />LABORATORY ~ <br />REMARKS <br />No. Idsntilication Time l7 v (Size/Mat'l) Slutlge,Etc.) ra <br />v ~ AP7t;t:~ To ALL S4+1P(.f.J L~SrE~ <br /> <br />3F2f3 9/g/9 ~ <br />/( <br />X <br />1 L PE <br />I.J4rP/C.. <br />/~LaoH <br />C /~ <br />W R 4~ <br />~ TOihL <br /> oo o r <br /> ~,~., j PE [~, 3 C l.t / zr,, ~ F~ . ~t . N4 <br />.f <br />ti I, f, <br /> 9[~/4a <br /> ~' u /lop u 1 L PE W~rEJL i~tol~ i_,{- <br /> soa,f ~E ~a~~ >I <br /> R'~-oE~o>< 4/v/4a X 1 ~ PE wra'~'Z ou <br />n/ sL <br />r' <br /> /or s a . <br />. <br /> SrX~r.t PE NHO t~ <br /> 9/ti/ea <br /> fbSC-DETox /030 ~ 1L P£ WATC2 ~pN ~~' <br /> 5oo,wt PE. NNOg ~ 1 <br /> <br /> <br />Ssmplers: (Sipnarurel Relinquished by: Date: 9 a( rJ ,~ Raceiwrtl by: Date: COC Seal No. <br />2 (Siynarurol ~ <br />Time: / '~ ~ (S;pnatun) <br />Time <br /> Relinquished by: Date: Received by: Dero: <br /> <br />Afflliatidn (Sipnatvrol <br />Time: lcip~-«...I <br />Time: <br />/rr+f~A~~. t A.SyaL Relinquished by: Date: Received by at ry ^ Dete.~J- - ntect: <br /> (Siynaturol <br />Time: (Sipnarurol i <br />p,{H ~ L <br />Time: <br />58 <br />REMARKS: Dese Re is To: IN a/Address) Laboratory No. <br /> A 9Y- 3~ <br />~ <br />~ t. f}(,prJA SCOT - ~'f6 <br />FA x 2~S t.t u g 7ro rIAL-C/>h~r•CA Ssoc, <br />~ 7 <br />Y 5 <br /> <br />While • Return With Results Of Analysis Yellow -Lab Copy Pink • Samples Copy <br />