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N4 10419 - <br />'~,' <br />COAE LABORAT OFalEB <br />~,:., w~l Analysis Request and Chain of Custody Record <br />"""°-`~' 1300 S. POTOMAC, <br />AURORA, CO 8001 SUITE 130 <br />2 (3031751.1780 <br />Project No. Cli ent/Project Name Project Location <br /> <br />Leb <br />ID <br /> <br />No. Field <br />Sample No. <br /> <br />Identification Date <br />end <br /> <br />Tima <br />m <br /> <br />D n <br />E <br />o <br />U ample <br />Container <br /> <br />ISizs/Met'l) Semple <br />Type (Liquid <br /> <br />Sludge, Etc.) <br />Preser- <br />vative <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br />REMARKS <br />5 t`c' "hu I rc~~. X 1~ I~ afu~ t~t1 ;Ta-I~.k. ~ ~ti~ C N <br /> ~ 'SF 11 0 . x S~~I I <br />ltd ~ <br />~v1~~~ed IU,~~s <br /> <br />~ <br />R 5b~. t I Zt{ L <br />x <br />1~1 i <br />tti~Kr <br />Rr <br />a <br />-To~ <br />O ~ ~~~ ~~/ <br /> ~ , ~ , <br />, <br /> - ~SDF `'~~ ~Z X 5~~- 1. ~~ Nf~~O. , D13~1~~~4 M,~ <br /> l~ "lpll 11~ a ~qL X 1a- ~. V+I~~'r I12~1~ ~'~ ~ ~~ ' <br /> <br /> -~~ 1- url~ <br />X ,,~ I ~ti~ ~~ <br />N~ <br />I~1 <br />DL~(it S <br /> 4 II ~ <br /> <br /> _~ II 7af~L X ~ I ~ ice" Ivu y~c''/~US <br />~~~~ <br /> • LI l <br />i <br /> 11 Z`} <br />3co <br />X <br />'1L I. <br />l~(A~~ <br />Yl <br />~ MlS71S <br /> ~,~ 11 Z'(~2 X amber- 'a Ufd ~r N ~ HOC <br /> <br />Samplers: lSfynsturoJ Re~nqulshsd <br />!Si naturo) ,r <br />/ <br />/ Dats: /~ yrr R ~eived by'~ <br />!St nsturol Date:/%2y9L <br />8~ COC Seel No. <br /> Y Time : Time: <br /> f tellnqulshed-by: <br />lSiyneturel Bate: //U Ili Received bY: <br />ISipnsturol Date: <br />Affiliation Time: Time: <br /> Relinquished by: <br />ISipnsturol Date: Received by Laboratory: <br />lSiensturolL _~~~~~~ Date:%~x-~Intect: <br />c~~~ <br /> Time : r Time: <br />aL/ <br />REMARKS: Date Results To: (Name/Address) Laboratory No. <br /> <br /> <br /> 2. ~1Jr ~tM/v C/Vs4."s'~* W <br /> <br /> <br />White -Return With Results Of Analyfis Yellow -Leb Copy Pink -Samples Copy <br />