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N° 10417 <br />'~~ <br />CORE LABORAT ORIES <br />i e« :ti~~.l Analysis Request and Chain of Custody Record <br />"-'0'-'^ 1 300 S. POTOMAC , SUITE 130 <br />AURORA, CO 80012 13031 751-1780 <br />Project No. Cli ent/Project Name <br />~ ~ <br />~l Project Location <br /> ,~ d~ ~ <br />Lab <br />ID <br /> <br />NO. Field <br />Semple No, <br /> <br />Identification Date <br />and <br /> <br />Time <br />m <br /> <br />{~ n <br />E <br /> <br />U Sempl <br />Container <br /> <br />(Size/Mat's) ample <br />T <br />ype (Liquid <br />Sludge, Ett.l <br />Preser~ <br /> <br />vative <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br />REMARKS <br /> <br /> <br /> ' _~F (il~ 7aUU~iw l~lP/Z !,~ D,3~lc'~c>l n~i~ s <br /> - <br /> ~C '-8>,l r~~iy !L/ /, 61i~ ~ n ~Z'1J~7°1.S <br /> <br /> <br /> <br />D U <br />y <br />Kc ~ - (.,Z. c z I <br />u. wad <br />U <br />- ~J ~D C'~(/ <br />1 <br />~ <br /> ~ <br />) <br />r <br />~11' (~ ~'(U L V <br />'l ~,11 <br />~lfW I <br />D <br />~T`~ rn <br />u u' / <br />~ ~ <br />/ ,,~ <br />3~1'W~ d /lam `f <br /> ~~ _ 9~~ ,~ ~,~ • x L.j I. ~ ~. ~t~i~l S <br /> Jzt - ~ I,1 n ~` ~ u ~' tilt (~~'L- 7~C_ <br /> <br /> Samplers: (Sipneruro/ Relinquishe Dete(( Z' Received by: ' <br />~ <br />" <br />~ <br />7 Data: /L <br />y9 COC Sae1 No. <br /> fSignarurel ~ ~ ~~ <br />c <br />~ <br />~ <br />fSigneturol <br />/•" <br />~ ~J <br /> <br />Time: ( ! <br />LV / ' <br />i d <br />Time: <br /> Rtrtittquished Date: ~~Z~ z Recelvad Dy: Date: <br />Affilletion fSipneturel <br />Time: <br />~J~Q fSipnerurel <br />Time: <br /> Relinquished by: Date: Received by Laboratory: Dete:~l~Z j j'Z Intact: <br /> <br />• f Siynarurel <br />Time: /Signstursl <br />Z CAL ($YY~ ~~ <br />lime: <br />REMARKS: Data/yR{-.elsu~^llts /TtI oI:,~(/N/a~melAddress) <br />~ <br />1 Laboratory No. <br /> l /VIYIC <br />- II'1 <br /> ~«~ ~22-Z~ <br /> 2. n.~1. o,-~ a~~d~. ; ~~ ~ <br /> <br /> <br />White ~ Return With Results 01 Analysis Yellow -Lab Copy Pink -Samples Copy <br />