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N" "1 U 4 l~. <br />~~,' t <br /> CORE LABORAT ORIES ~ <br />I ~r~:r o~i Analysis Request and Chain of Custody Record ' <br />""'°~'°'^ 1300 S. POTOMAC, SUITE 130 <br /> AURORA, C080012 (3031751-1760 <br />Project No. Clien[/Project Name Project Location <br />Sa9M ~a~~ lt- Mf~l . G O(./~ ,S,ar.l Lu(5 <br />GO <br /> ~ <br />Lab Field Date n Semple Sample <br /> <br />ID <br />Semple No. <br />and <br />m <br />E <br />Container <br />Type lLiquid <br />va <br />iv <br />N <br />LYSIS <br />EOUESTED LABORATORY <br /> <br />No- <br />Identification <br />Time <br />t7 <br />u <br />(Size/Mat Il <br />Sludge, Etc.) t <br />a <br />1ji ANAL S[ S <br />Aq' <br />~ <br />D <br />~ r4t-L_ S.a~u~--.cJS. REMARKS <br />,/ <br />tJ <br />~_ ~-oX to/r~~4~. <br />I'73o <br />'~ <br />1 L P~. <br />war-E2 <br />NgoN <br />C.J ~ <br />F~rAL_ <br />wnp, <br /> r <br /> Soo..t PE Nr~03 Gu <br />Zr.l Mr,1 <br />N,. <br />Fe. <br />n!a <br />Ca <br /> r <br />1 ~ <br />~ <br />r <br />~ <br /> <br />POS~'06t'ox ropy/9a <br />~ .SA.Lt- AS <br />' <br /> t6oo ' ~pyL Vt_ <br />WAr SArxc AS A3o~t <br /> <br />~~ <br />~'~+ s0/t5/q 0 ~ ~1d`q Al <br />~ 0930 /Y3o~L f.JATt/Z- SA^'~ r4S A3ov-G <br />I ~_~ t~~ <br />f90 / SA,r-c AS <br />" <br /> I ~py~ WAI <br />b2 Stiff AS ra3o~, <br /> to/r5/9d Se.s.t- A3 <br /> C'A 1930 / p3ov-r- WA~f1L SA.r+~ As A3o~c. <br />/y.t <br />v <br />C(SL'h /o/rS/48 <br />~ 5't^~ AS <br />d rgoo Ar3o..~ Wks SAw~c- AS ABpNC, <br /> <br />11 <br />3F~ ro/IS/9~ <br />'~ S0.•e AS <br /> /ooo „ge,n ulak/Z, SA,t,c /3-S A3v,rc <br /> <br /> <br />as-ISS /o .y •9.~ <br />~,~. <br />/ <br />i - l` t~- <br />lam <br />N/A <br />'1 SS <br />Samplers: ISipnsfurel Relinquished by: Date : fU/! a ~~ a Received by: Data: COC Seal No. <br />2. to b-ZrR ISignstunrl tL. \O <br />_Ut <br />Time: /y4U /Signeturel <br />Time: <br /> Rellnquished bY: Date : Received by: Dale: <br />Affiliation /Signature) <br />Time: (Signeturel <br />Time: <br />b6ALEp>•~MA .` aysoL Relinquished by: Date : Received by Laboratory: Dete:lp ,I b,Q f~9ct: <br /> ISlgnsturel <br />Time: ISlgnerurol t <br />,s 71 <br />Time:IN ~. ~~ <br />REMARKS: Data Results To: (Name/Adtlress) Laboratory No. <br />~X (2 GSU t1 s vo !fR r~ <br />oibSrcA ti A sSc>G 74~l-3 aY [' ~~'a SC'OTT - !3MG <br /> r . S <br /> <br />White -Return With Results O( Analysis Yellow - Lah Copy Pink -Samples Copy <br />