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',t~~ CORE LABORATORIES <br />MFeecern 4tlee <br />Internetionnl <br />raye ol_/- <br />CHAIN OF CUSTODY RECORD <br /> CUSTOMER INFORMATION PflOJECT INFORMATION ~q <br />COMPANY C / /'/ r~ U <br />l !V PROJECT NAMHNUMBER ~ I <br />SEND REPORT TO <br />~;~ <br />BILLING INFOR <br />MATION <br />= <br />~~ I~r <br />CI) <br />ADDRESS BILL T0. F <br />Z y OJ <br />~ (V /~rti <br />+U <br /> ADDRESS V V Q' <br />, <br />aP <br />~ <br />LA <br />B <br />JOB N <br />O <br />. <br /> o ~ ~ e ~ <br />~ <br /> W Q ~ <br />v ?C G ~ <br />~ <br />, <br />~ <br /> <br />PHONE <br />PHONE <br />m ~ I ~~~~J <br />FAx FA% PO NO Z <br />~~ <br />SAMPLE NO. SAMPLE ID SDATEE SiMEE MgMq~X CONTAINER TYPE PRES. REMARKS/PRECAUTIONS <br /> - 3 2 i' (- Kea ~~~Q <br />y/~D- ~ <br /> <br /> <br /> ~C -'f ~ ~' i5~ ~,0 1t I I <br />s ~ N' ~ <br />Cc; - ~.S 3 <br />zb , ls~n <br />iszv ~ .~ <br />, L~, 51sCn <br />tip, ~ ~ k~ <br />K ~ <br />~ <br />5 - ~ - ~rCC <br />v ~ t ~ Za ~s~ <br />Co - z~ `l ISW ~ 2~;up ( s ( <br /> <br /> 'C -~ 5'I' 3 j 1~i0 1~ 1~2 / S ~ ~ ll <br />SAMPLER ~ Q SHIPMENT METHOD gIRBILL NO <br />REDUIRED TURN OUND.' ~ SAME DAY ] 2< HOURS ] 4B HOURS C ; 72 HOURS ~ ~ 5 DAYS C ] 10 DAYS ^ ROUTINE OTHER <br />1. RELINQUIS D Y'. DAT 2. RELINQUISHED BY DATE J. RELINQUISHED BY: DATE <br />SIGNATU ~~ ~~ 'JL~~ Ly I-. <br />l <br />1 <br />~ SIGNATURE. SIGNATURE' <br />PRINTED NA Fl~ MPA '/ ~{ l J,~ t ~ ! J <br />i / U` ,Y l iW~ <br />~ <br />,~ <br />I <br />/ <br />` fRNlTi$~ TIME PRINTED NAME/COMPANY. TIME <br />1 RECEIVED BY: D <br />A <br />TE 2. RECEIVED BY DATE J. RECEIVED BY: DATE <br />SIGNAT '/~{`C_.~~~/ J ~ ,, <br />l ~~,y_,3 SIGNATURE SIGNATURE' <br />/q <br />PRINTED NAMEICOMPANY:/0 ~~ <br />C ( TIME 7 <br />Wiz; PRINTED NgMFJCOMPANY: TIME PRINTED NAME/COMPANY: TIME <br />nwn lunnnnv~nv mgr r.~w~r.~wn~~r.r.oc <br />^ AmMlm, Ctlih]rnle ^ Lwy flaacN, CelltorMa ^ fhnrer IAurprQ, COIOOtlO ^ Cnpeq WYaminq ^ Hpunpn, Teeee ^ Houtlpn, Tew ^ Coryue ChtlfO <br />Taw ^ Leb Cherlel <br />LoulaUne <br />1150 E. Gene Amy Way J)00 Lheiry Avenue 1J00 $ Polmac 51 ~ Sune UO 1)0 Wesl Is1 Sheet 10]01 weslneimer. BN9 I A 8110 Moseh Rana , <br />t]JJ NonM1 Patlrp IAentl Dr , <br />J6e5 Antpna Sreel <br />Maheim Cahlprnia 92A05 lory BpxA. Calnoma 9000% Amara. Cdorae9 00012 Casper Wyoming 02P01 Hpuslan. felas )1012 Hpuson. leas 1)015 Corpus Cnnsli. ferns ]0100 Sulphur, La~sana )066] <br />ptp 9JLlp91 1]1015958101 1]gll /5b n80 1]11]12]55)11 P1])9R~6100 111]19eY9))fi <br />(517120926)7 <br />13101583~I9Z6 <br />nralr,IN~I <br />