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i~;~~" <br />CORE LABORATORIES, INC. <br />No. 48756 <br />CHAIN OF CUSTODY RECORD <br />"' CUSTOMER INFORMATION ~ -~ ~ fP~i ~(3TTINFOBM , . ~` m. s x <br />a <br />,~q <br />COMPANY 1 ~ ~~ PROJECT NAMEMUMBER ~~. - <br />(/1` (~ <br />a7 <br />SEND REPORT i0 / <br />l BILLING INFORMATION <br />ADDRESS `~D lD <br />X-~ BILL TO: <br />~ <br /> <br />~ /~~ <br />ADDRESS: ~ w <br />LAB JOB NO. <br /> ~ I GI3 ) <br />PHON <br />E' <br />~ A7- /A , ~ PHONE: ~ <br />~ <br />7 <br />P /~~ G 77- ~3~3 FAX PO NO.. <br />SANPLE ND. SPMPLE DESLRIPTION <br />, y~Mp L€., <br />_'~`D TE SANpIE <br />„ nME , SAMPLE <br />.; nwrnlx CIJrJTAINEfl E. <br />~ A. "~ flE5ER1(: <br />:~ .. ; ~:: <br />~ 4 <br />_ EMARKS. /;PRECAl~T1t? S <br /> OI ~~, I I 7.3°~ cP <br /> t3 GD3 bib 1 I 4s,i °`' <br />3 1 'Q Yh 4 Ib45 1 1 p~ <br /> o m as Do 1 P,a.- <br />5 ~ V3m ~ a o <br /> (3r~,G I S ,~~.~ <br /> <br /> <br /> <br /> <br />SAMPL ~_ ~ _` SHIPMENT METHOD: AIRBILL N0. <br />REQUIRED TURNAROUND' J SAME DAY I I 21 HOURS C 146 HUUR$ ^ 72 HOURS ~ J 5 DAYS CI 10 DAYS CI ROUTINE OTHER <br />I. ELINDUI$HED BV DAT 3. PELINOU SHEDBY: ' DATE SIREL (SHED BY:. DATE <br />IGNA ~ ~ ~~ SIGNATURE' SIGNATURE: <br />PRII EQ~ FJC <br />L RECEIVED BY: <br />ATUR 8pD': ~ <br />~: r s ME w . <br />D E u PRINTED NAMFICOMPANY <br />ECEIV :4`-.E' ~~. f ,k <br />SIGNATURE: TIME <br />DATE PRINTED NAMEICOMPANV: <br /> <br />SIGNATURE: . 71ME <br />DATE <br />PRINT D NAMEICOMPA Y: T E PRINTED NAMFJCOMPANY: TIME PRINTED NAMElCOMPANV: TIME <br />HUSH TURNAROUND MAY REQUIRE SURCHARGE <br /> <br />^ gna6um, Glilomil qunn IOarel. Celurda <br />1750 E Gene qmw War 10107 E. Bnhlnv Onn <br />Anahnm. Llllln~Ni 91605 Avon. [oiontla 60011 <br />Vu197/ 1091 17071151 1180 <br />160011917617 16001913 7617 <br />^Ce6v, WYnelnl ^CUpn Chnnl,TVn <br />q0 Wat In 61n1t 1777 NonM1 P1tl11 Hbntl Drive <br />Gaon, WYOminp 87601 [prow Chrini, Tau 78106 <br />1701N796/a I61A 3693677 <br />16001 6660]116 160015161376 <br />^ Mounw, Tnn ^ 114 Chele, Lwuw1 <br />8710 Monty Road 7619 Bgli, grheoY <br />Hounon, Tun 11079 Sulpnm. Louubru 70667 <br />111719179716 171619671976 <br />16 0 01 1 717 61 7 IB001799 ~ 976 <br />^ luN Meh, 4Ylarnio <br />7/00 LherY Annw <br />Lory Baach, filHOrnu 90907 <br />01019991101 <br />Ifi6616u 7a7 <br />ORIGINAL <br />