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N° 10423 <br /> <br />'~~~~ ~ <br />CORE LABORATORIES ' <br />. <br />,':,'`,~etio~ Analysis Request and Chai n of Custody Record ' <br />"'~"'~~^ 1300 S. POTOMAC, SUITE 130 <br />AURORA, CO 80012 (3031751.1780 <br />Project No. Client/Project Name Project Location <br />5a8y 3A'tTLE Mrnl Go~1~ ~~ ~utS <br />cp <br /> ~ <br />Lab <br />ID Field <br />Sample Na. Oate <br />and <br />m o. <br />E Sample <br />Container Sample <br /> <br />ype (Liquid <br />T <br />Preser- <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br /> <br />No. <br />Itlentitication <br />Time <br />t~ <br />U <br />(Size/Mat'I) <br />Sludge, Etc.) vative <br />~ SEE TAOLIs, ~ Fo2 C,yM PY2rE <br />(J'S i REMARKS <br /> 1o(ra~99 (d) <br /> tZS- ~ 1430 '/ Seo..t ~L'. u1ATt2 H.JO ib~ A c. t JrSsot.vc,o ME;AL.S <br /> fa) <br />1t. Pr` <br />HrJO3 rf" <br />1c/sD10 CMtJVi <br /> . 1 L PE /tkt.o Fl cr.l ~ ib ~ AC , W l1f-~~ <br /> Ic. PG M~Jo2 f1n1rO~IS <br /> a5ta,.,f PE ZJAC Su r_F; DE <br /> T L 61 ~t.So Ol L `~; 62fA S c. <br /> 5~rt 61 NzSoy 'raG, n1N3r nlo3+ nJpa <br />~ Rs-a 1O53 <br />' / ~~ ,,~,~;t/L ~d..c.. as a3ou-c <br /> o . <br /> <br />t <br />R S - 5 ,o~ra/na <br />/e, 5 ,/ Sons ,aS <br />Awe t.G <br />~!A iZ°1L <br />`.y6/"tc- A S .430 o-c._ <br /> <br />Samplers: lSignsrure/ Relinquishetl hy: Date: /O~/6 qa Receivatl by: Date: COC Saal No. <br /> <br />(2.. t ISignsturel <br />~ ~ ~ <br />+rJ /yY0 <br />Time: iSigneturel <br />Time: <br /> Relinquished hy: Date: Received by. Date: <br />Alfilietion lSlgnarure/ Tima: lSignsrurel Time: <br />FIA tL~ASsCA t, A~}oe~ Relinquished by: Date: Received by Laboratory: Date~,(b.Qa Intact: <br /> lSlgnerure/ <br />Time: /Signerurs) <br />f <br />Time: j~: yD <br />REMARKS: Data Results To: (Name/Address) Laboratory No. <br />ro <br />T 5 <br />~gN. <br />f2 <br />F /facLP~as+~ ti Assoc 79` <br />-3 x45 '~ Ac.t~1A Scores ~ 3.t~G <br />- <br />. <br />. <br />ayc . 1 <br /> c~,.1,, <br />`~ ~ Jam/ <br /> z. fLac< 7~P/~E2 ~ N/lcfpfs.c/+ <br />White -Return With Results Of Analysis Yellow -Lab Copy Pink -Samples Copy <br />