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'~~ CORE LABORATORIES <br />wr.e.6.. nw. <br />InsemetJonsl <br />Page ~ of <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION PROJECT INFORMATION DO <br />COMPANY. ~j )~ <br />0. f PRQIECT NAMEMUMBER: <br />SEND REPORT T0~ ,^ <br />s <br />, ( BILLING INFORMATION ~ ~~ <br />~ ~ <br />ADDRESS: / C~ r BILI TO'. ~ry '~~/e <br />Off"' ~ F <br />^ <br />y OJ _J <br />~ <br />~ <br />~^r <br />f-V ADDRESS. ~ P" ~ <br />~ <br />g' N <br />C' LAB JOB NO <br /> <br />''L-y/`I' <br />~ <br />~ <br />~ <br />fi <br />P <br />x~ . <br />(-~'](-~' <br />~ <br /> <br />PHONE j ~ - <br />r ~) <br />•JJ ( <br />PHONE' <br />~ ~T <br />I <br />J - `-~-' <br />FA%' A~~_ ~~~ <br />./ ~ FA%: PO NO. Z <br />SA/APLE ND. SAMPLE ID 0~11~ Pff~ ~TRI% CONTAINER TYPE PRES. REMARKS /PRECAUTIONS <br />r ~ - l ~ q ~.~ ka0 lL l , / X <br />~ - l Gt 3 13 Zo ~iDa+Q l N I s = C'a ll~t L}~ ~, <br />~ - ! ~ a-~ ~~ ~sa,~.o I s r <br />2 ~c ~- 2 u 21~ lws~ K~ 1~ l cY1 l x <br />3 ~ - 2~' 9 1 is zp I~, l (.'~/ <br />z - 1 1~1s z6 ~~e ~ N <br /> ~L - 3 /r Sao) KNII l <br />Z C- ~U 3 1 ~ za MG l <br /> - tg I 2,S'D ) B l <br /> ,. 3 (3 H2U ~ l / <br />SAMPLER r ~' SHIPMEM METHOD: AIRBILL Np. : <br />REQUIRED TURNARWND' ^ SAME DAY ^ 2IHWRS <br />L REl1N0U D BY: <br />SIGNA R ^IBHWRS ^72 HOURS ^SDAYS ^IDDAYS <br />DATE Z. REl1N0UISHED BY: <br />SIGNATURE'. ^ROUTNE OTHER <br />DATE B. RElINOUISHED BY: <br />SI~NJtTURE <br />_ .~ <br />PRINTED AM PANY. Ly <br />1. RECEVED BY: K <br />SIG 1 ~O <br />DATE <br />~Z~_ PRINTED NAAIE/COMPANY. <br />t. RECEIVED BY: <br />SIGNATURE: TIME <br />GATE PRINTED NAME~OMPANY. <br />7 RECEIVED BY~ <br />SIGNATURE' TIME <br />DAiE <br />PgIHTED NAMHCOMPANY: ~-~ /~ T]~1Ez J~ PRIMED NAMF/COMPANY~ TIME PRINTED NAMEICOMPANY. TIME <br />^ An•Mw, C•IIbrN• <br />1250E G1ne ANry Wel <br />AnIbM, [JMMIY 92805 <br />pt11 pj1.t091 <br />'c^ Laq pe•eR CMIaNe ^ D•nr•r (AUran), Cgaetle ^ Owpw. I6leminp ^ 119u•Im, fien ^ HeufnM1 Teu• <br />]100 Awry AnnYl I]IO S Pdtlluc A ~ S~Ae 110 170 We91 q 5eM1 10201 WBWe•r. BM9 I~A GIO Moeeh Ro•0 <br />luq BuA, C~MMai4 90801 Aumr•. Cebnao 80012 Pieper, WymiN 82801 IWgT, T•eu 11017 Idnlm, lew PO15 <br />I]1015958Wf I]m1151~t16o 170112]Si11f Ill]1912E199 (il]I9119T16 <br />^Cerµn CTn•tl. T••e• ^WCnerM~LWI•lene <br />1 TJO MaF P•b•IWN A. ]MS Aeteru Sml <br />Cable CMtl, ieeee IMOB Sipnn, lamu.a 10667 <br />is1217e 261] 1]16156]1976 <br /> <br />ORIOINCI <br />