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o , ,. <br />'~~ CORE LABORATORIES <br />i~~""e.r` :'r.Ab ~ <br />"'~'0'~°^ [300 S. POTOMAC, SUITE 130 <br />AURORA, CO 80012 1303) 7571780 <br />Analysis Request and Chain of Custody Record <br />Project No. <br />Sa~~t Client/Project Name <br />13~TLC <br />I~I~rv GcL_I~ Project Location _ <br />S,q,J (J.Ir S <br />Lab <br />ID <br />No. Field <br />Semple No. <br />I~nZTCetion Data <br />antl <br />Time <br />a <br />t7 c <br />E <br />U Sample <br />Container <br />(Size/Mat')) Sample <br />T <br />Sls d eLE~ic~ <br />9 <br />Preser• <br />vative <br /> <br />~ . ANALYSIS REQUESTED _,., <br />ACC TM1?xq, 1 r~.2 (~rvsr c.tlY` U S r <br />LABORATORY <br />REMARKS <br /> 9aja0~ <br />3+.tnGo 1 +a/og la <br />/33o (a <br />Soo,,,) Fc <br />tNAi~lC <br />lfrlo3 <br />iZ~SYiL ANo DiZ~iL~tip /77G7gLS <br /> cap <br />1 L ~~ <br />Nr~• <br />2A>7toCUCM <br /> 1 L F~ ~G~u CfJ (~~,~ t.~rn~ <br /> 1 ~ PE - ~~H :2 Aa:o~~ <br /> as;=>"t I'E za~c. sLf«=apt <br /> 1 L_ CAL I,ZS=y e. L. « G~?~,~- <br /> 51:^....I G1 11ZSoti ;~C, til/-l~ r`c3 + '`'C~3 <br /> <br /> <br /> <br />Samplers: /Siyneturel Relinquished by: Date : /a/ir~9r~ Received by: Oate: ~ C Seal No. <br />n <br />1 `-' (Signature) <br />Time: / ~ 30 )Signature) <br />Time: . <br /> Relinquished by: Date : Received by: Date: <br />Affiliation (Signature/ <br />Time: /Signature/ <br />Time: <br />/~ <br />//r316/'RyK/} '~ /tS~pC, . Relinquished by: pate : Received by Laboratory: Dace: ~ Intact'. <br /> (Signature) <br />Time: (Signature) <br />Time: <br />REMARKS: / ~ ~ GU <br />F <br />~ <br />~ lo~(<>3 <br />~ <br />' <br />~ <br />A <br />~9~I- <br />L Deta Results TO: (Name/Address) Laboratory No. <br />,t (~L <br />.Ss.sL,S Tt, <br />r n <br />ilctl <br />. <br />N•~L[ SS~c. 3-~ IS <br />y ('~ - ioPPlrlZ - t IrALfI'AS~14 <br />°~~>Obr~ <br />Feu <br />t~- <br />w <br />u.. <br />u <br />White ~ Return With Results Of Analysis Yellow -Lab Capy Pink ~ Samples Copy <br />