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I'%i <br />CORE LABORATORIES, INC. <br />No. 63691 <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION ' " "PROJE~CY INFORMA710N a `_ <br />~ < ` ~ O: '' _ ~Or <br />COIAPANY n ~ ~ _ ! ,~ <br />W ~~/, PROJECT <br />NAMEJNUMBER' - ~~h .~`O~y ~ ~ ~i_` <br />~ <br />\C• <br />SEND REPORT TO BILLING INFORMATION W 7 <br />y~~ <br />ADDRESS: I O ~j 1 O BILL TO <br />~ ~ a ADDRESS ~` <br />LAB JOB NO. <br />~~ \ <br />~ <br />'~ ~ ZCg 3 <br />PHONE ~\ ~~ ~ I~W r I~ <br />G PHONE ~.~' <br />~ :; _~ ~ J' <br /> v <br />~ <br />SAMPLE NO. SnNPLE DESCRIPTION ~~~ <br />DATE' $ 54NN'LE <br />eT1ME °~ SAA'ffLE <br />Sg1gTRl%'., 7{AINF~R <br />~ ~ SE, <br />R~ ~' <br />~~.'' i~.~ <br />~/ <br />~ REMARKS /PRECAUTIONS <br /> leD"-3\Bu\ U 13 qb og3b ~ I 71 c G <br />a l PA O~iSa I ~ 46]a°-~ <br />3 ~l¢073~ M o3 lD 13 \ i -r <br />`~ ~~ 1 0 3D I <br />5 GS i OSo i <br />(~ q(cp 1 M d ~ 1D55 I <br /> <br /> <br /> <br /> <br />SAMPLER. T <br />V SHIPMENT METHOD AIRBILI NO.: <br />REQUIRED TURNAROUND • SAME DAV <br />2a HOURS ^ <8 HUUR$ L~ 72 HOURS I ] 5 DAV$ ^ 10 DAV$ I-] ROUTINE OTHER <br />). I$H B ' DATE 2. RElINOUISHED BY: DATE 3: RElINOUI$HED BY: DATE <br />SIGN T E / ~I? 1I/~I <br />J <br />_ <br />lN SIGNATURE: I SIGNATURE. <br />PRIIITE N{JGOIdQ V. ,^ TI~1 <br />~ <br />_ PRINTED NAMHCOMPANY: TIME PRINTED NAMFICOMPANY iiME <br />I. RECEIVED BY: TE .ai C VED'BY: - 5 ~. %~ a1 ~ DATE EGEIVED BY F DATE <br />NATO - SIGNATURE: ~ <br />~,.- SIGNATURE. <br />PRINT D NAME/COMPANV RIMED NAMEICOMPANY: TIME PRINTED NAMEICOMPANV TIME <br />a <br />u <br />a <br />C <br />a <br />c <br />a <br />a <br />z <br />a <br />r <br />^ AneMn, G <br />IxSO E.Gnf wry <br />wunwn: low mn mal vo <br />n. e]1 <br />^ Ngnbn~ TY N.11 <br />NIO MWeI FpM <br />Nwrm. T% Iron <br />(11]1 eaTaTn Fu (!I]I eaJNe <br />/"1D1~m E~Bwiur <br />plw ~FIrq StrM <br />~ ~A W ~ <br />tln <br />y <br />,1.yr~DD e00n <br />P411 n1-ITeOfu PM1'1)nI.IIN . <br />Lapr. N'!el'e01 <br />Pp1111YpnI FU POT'A ten I N. P <br />Yflq DMf <br />UM,T%lyUe <br /> .PI xi]OnFU lel9f IIFU]1 <br />0 YWrnytlb.IM <br />PM Mylr Hate ~ IW CNrI]S u <br />tpu g <br />Y P ^ l.mY M[R ~ <br />. <br />]) U <br />4r,'YrnptlLLlN 4QY ~f <br />. <br />erhFaY <br />aQiur <br />lA TM61 r <br />~ BMyI; G 0000] <br />P1n eleaeW FU Pln snal® . <br />P14 ee]+Yxefc Plel 061+0x0 ~ plol eeSIWI FU P1014'lat]/ <br /> ORIGINAL <br />R~rM Gnlr PNw~y <br />FAIFT. H10e617 <br />leeel3aalW Fu level xaam <br />Trny4 FL <br />e]eo eson~rn Draw era. <br />T R Sl6l. <br />1st] ee4exM Fp 101]1 ~+e]e <br />(] He1tlm. TM IEe]1 <br />Hilo ROe... Dm. <br />NaMn. T%llpq <br />IFI ]I OY64M. Fu Pt]) 6f04M! <br />Vflpnlu.IM <br />x.oo ryme.n.rie Dme <br />VYrynb.IN M'ISI <br />Ixlel.e]~x]ee Fu Ixlel.ai~xesi <br />