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~.~ v <br />~~ CORE LABORATORIES <br />~"e., ~ ^ebr~".f <br />"'~"'-°'^ 1300 S. POTOMAC, SUITE 130 <br />AURORA, CO 80017 (303) 751 .1780 <br />Analysis Request and Chain of Custody Record <br />Project No. <br />sae4 ClientlProject Name <br />~~1-c~ <br />Mi-N. <br />Gou> Project Location <br />sa•.~ c.u~ s <br />Lab <br />ID <br />Ne. Field <br />Sample No. <br />Merttif;cetion Date <br />and <br />ThRe <br />m <br />l7 o, <br />n <br />U Sample <br />Container <br />is;ze lFAat'll Sample <br />Type (Liquid <br />Sludge, Etc.l <br />Preser- <br />valve <br />ANAtySf9ftEQtlE3TfD ^, <br />~c a~E ~~r_~ ~ Fo/(. CoMPW"2.. ugl <br />L R@EMARKS V <br /> 9a}al/ <br />i3~tG o 1 1zln/yL <br />to ao ~ <br />Soo.nl PE <br />WrM-EfL <br />//.~o <br />17~SSo~.tx1J /17Gi7Al.S <br /> ca) <br />1 L ~ <br />ff~o <br />2A~pJp cNEM <br /> 1 t, PC /Jaop CN ro ~~ , w,~, <br /> 4 ~ nc - M~ 0 2 ~,~ t~3r•' S <br /> .n{ ~~ Z~dlc. 5ut~'Ai~ <br /> 7l. GI /f p~~ Y,. G/reASC.. <br /> <br /> <br /> <br /> <br />Samplers: (Signeturel Relinquished by: Date : /01 I ~ Q a Received bY: Date:/~'J jj COC Seal No. <br />-y <br />+G (Signeturel ~ Time: /~j30 (Signeturel Time: / <br /> Relinquished by: Date : Received 6y: Date: <br />Affiliation (Signeturel <br />Time: (Signature) <br />Time: <br />( ~ ~'bSeG~ Relinquished by: Date : Received 6y Laboratory: Date: Intact: <br /> 1Sipneture) <br />Time: (Signeturel <br />Time: <br />REMARKS: P~ A• ~os7b '~ Date Results TO: {Name/Address) <br />,. cANA Sc>or% - 3tuG Labgratory No. <br />~ <br />r FaX REsuu S za /-~+~ev~. 79Y-3?t5 7.2 . To~P~ _ 1~~~. 92222 <br />CA, <br />tr-- <br />i,~ <br />(~- <br />White -Return With Results Oi Analysis Yellow -Lab Copy Pink -Samples Copy <br />