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<br />CORE LABORATORIES, INC. <br />No. 55382 <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION e ; r ~ PROJECT 4NFORMATION • ~O <br />~ <br /> <br />COMPANY: <br /> <br />~_ ~ <br />PROJECT <br />NAME/NUMBER: <br /> <br />, ~ <br /> <br />~ ~ <br /> <br />~ <br />SEND REPORT To ~ BILLING INFORMATION ~Q <br />~ °' <br />z 1 _a~e <br />J <br />~ ~.'~ ,~~y .- 0 F <br />0 ~ <br />ADDRESS BD J~~ BILL Tp ~~~~ :~ ~ ~~~~~` <br /> <br />S/~ /v <br />Lu i <br />/ ADDRESS ' U <br />~. ~"r?Q ' <br />~ <br />LAB JOB NO. <br /> <br />W . <br />~. pp (( <br />A <br />1 ~`.` s ~ (, ` <br />( '7 <br />Z36 <br />PHONE ~/ _ ~ L_ ~/ <br />G PHONE ~ ~ <br />v <br />e / ~V V <br />,` ` <br />FAX <br />7i9 <br />6 7~ - 3363 fAX PO ND. ;? -~ ~' ~~ <br />~Q <br />5 <br /> <br />Sg1r1PLE NO. <br />SgMPLE DESCRIPTION <br />SAA9LE <br />SP1v1PEE <br />~ RL% <br />CCNpTAINER TI'PE <br />~ <br />PRESERV. ~ h <br />` ~ Y\ r <br />REMARKS / PRfzCAUTlO S <br />/ 96a8aoB/fj O/ opso //OO wnrER P~fse / / / l no r, ,,~° <br /> 5 ~° <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER. TO M /I YT/ NI.° Z SHIPMENT METHOD AIRBILL ND. <br />REQUIRED TURNAROUND' I i SAME DAY 24 HOURS 48 HOURS ~ 72 HOURS 5 DAYS L IO DAYS I ~ ROUTINE OCHER <br />1 RELINQUISHED BY: DATE 2: RELIN tSHEO Y: ~ ~ ~ DATE 9. RELINDUISNED BV: DATE <br />SIGNATURE o/lO ~ SIGNATURE SIGNATURE: <br />PRVITE AMEICOMPA - S ~y/ TI E/S PRINTED NAME/COMPANY TIME PRINTED NAMFJCOMPANY: TIME <br />I RECEIV BY A7 2: RECEIVED BY: " ' DATE 3. RECEIVED BY: DATE <br />IGNATU ~~ SIGNATURE: SIGNATURE <br />PRI ED NAME9COMPANY IME PRINTED NAMNCDMPANY: TIME PRINTED NAM6'COMPANY TIME <br />RUSH TURNAROUND MAY REQUIRE SURCHARGE <br />^ ° <br />An.n.im. carm~.,a ~a°nn lomml. c°Inmp <br />1150 E Gene 4uvr Way 10)07 E BnMny Ouve <br />Awneim. 6aldpmx 97605 Aurpn, C°Ipntlp 80014 <br />111419J11094 17071151 1760 <br />160014041617 160019114617 <br />^ Gpa., Wvamin, ^ Carpn Cfirlni, Tun <br />40 wen In Sues 1177 Nprtn P+tlla hl+ntl Orin <br />G4per. Wypmmp 87601 Cprpm Cmnti, i,w 16406 <br />170111355141 15171 tB9 7677 <br />Ifi0016fi60)Ofi 16001546 ffi76 <br />^ Hunpn, Tun ^ lab [bma. lauiaiua <br />6110 M°Jn P4+tl 7645 Bgln Partway <br />Hpunpn, iem ]7015 $VIPM1u(. Ipmuana 1066] <br />1113194J~9116 I7161563A976 <br />16001 1314617 16001 159-0976 <br />^ loop fiu46, hlilamia <br />7]00 Cnenr Avenue <br />Long Bucn. blilprnx 90601 <br />17101 59 5 6 401 <br />16001614 J~77 <br />nav;m7nl <br />