Laserfiche WebLink
<br />r1° 10415- <br />'~' <br /> CODE LABORATORIES <br />t wr ~ Analysis Request and Chain of Custody Record <br />"'~'°'~°^ 1300 S. POTOMAC, SUITE 130 <br />AURORA, C0 80012 (303) 751 ~ 1780 <br />Project No. Client/Project Name <br />R ~f-{d G~1~ <br />~i1( Project Location <br />Lab <br />ID <br />No. Field <br />Semple No. <br />Idantilicetion Dete <br />end <br />Time <br />m <br />t7 p <br />E <br />U Se ple <br />Container <br />(SizelMet'l) 58 ple <br />Type (Liquid <br />Slutlge, Etc.) <br />Preser- <br /> <br />votive <br /> <br /> <br />NALYSIS REQUESTED <br />LABORATORY <br /> <br />REMARKS <br /> <br />I <br />'~0C1 " ~u .1 23 <br />i~~ <br />.x <br />1 ~ ,~. <br />t~~~c- <br />ti~~l <br />~ To-~,P a'Gc~( ~~~D C'N <br /> <br /> <br />-~F 1/jZ3 Z <br />~~ <br />x <br />5tva~t/Fi, <br />~~ <br />~~. <br />~ <br />t3~~F~d ~~~~ <br /> II z~/v~- k 51A1 ~11f f~ I~~~ klllU~ -T <br />~JZ ~~'~ <br />f' <br /> ~ O <br />. <br /> <br />Rya - r u If jZ3r~iZ <br />3o <br />X 5Z0 ~ <br />~,- ss <br />urad~r~ <br />y <br />l <br />ToC <br />z ~ ~- 2u I /iG 5 2 X ~ ~ Pl. i~~ ~acw . 7 f~ a,>~( [~ ~N <br /> _ _ , !j Z~ <br />l5 k ~~e rl. t~~~ K ~ red ~~.QJ <br />~- <br />3 ~ - ~,t nl2 oz x ~L P!, ~,~,~'~ ti`~OK o ~'~ Cti~-D CN <br /> <br /> <br />~ ~ ~-~t~ j1~23 _ X t ~ pt: ~~ N Tea Q ~c~( Eti~ GI,~ <br />Samplers: (Sipnetunrl Relinquished Date: ~~ ~ Received by: Date:/;L y COC Sael No. <br /> ISignetunl t <br />Time: <br />~p V~ rSi nstu <br />g /~'~ <br />Time: <br /> a.urewny Dete:/~/2.r~~ Rb'': Da>c: <br />Af/illation Isi Time: ~ya rsig Time: <br /> Relinquished by: Date: Received by Laboratory: <br />' Date: /I.2$~ L Intact: <br /> rSiyneturel 77 ~~,, .~ <br />(Signeturol /~ <br />V u $~1 (7 ' <br />aD <br />9 <br /> Time: Time: <br />: <br />REMARKS: Date Results 70: (Name/Adtlressl <br />~t <br />S ~ ~$ ~ <br />ue Laboratory No. <br /> ,. in <br />~e ~~~-s <br /> C a8/er- liar <br />' y <br />d 92212 <br /> 2. ~ Dr~,~U~/ <br />p er CC ~ <br /> <br /> <br />White ~ Return Wi[h Results Of Analysis Yellow ~ Leh CoDY Pink -Samples Copy <br />