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i~a-~y <br />CORE LABORATORIES, INC. <br />No. 48768 <br />CHAIN OF CUSTODY RECORD <br /> CUSTOMER INFORMATION ; ; ~:. ; PROJECT INFORMATION. ~ 1 ::0~ g <br />COMPANY <br /> <br />SEND REPORT TO <br />m~I- tiL ~ <br />/ ^ / `E- /j <br />J / <br />/7 PROJECT NAME/NUMBER <br /> <br />BILLI4G INFORMATION i, ~ <br /> <br />, `~' >ry <br /> <br />~~~ <br />ADDRESS ,5 D <br />O <br />~ BILL iO wA ~ .. ` <br /> <br />./ LK/ CO , 8 /S2 AODRE55 <br />0 ~.e „ <br />= ~ <br />• <br />LAB JOB NO. <br /> 4 ~ <br />g <br />PHONE ^ _ / / XT, /S PHONE m, ", . ' ~\ <br />FA% 719 7.2 -33 6 3 FAx: PO NO : ~~ <br />SANPLE NO SAMPLE DESCRIPTION ~ SAMPLE ~ <br />D. SAMPLE <br />„ ,TIME $AA9LE <br />MtATRIx . CONTAINER 1r E <br />.P fRE$ERV. <br />(,~ ~ <br />~ 13EN1ARKS;/7~PRECxA~~gt~S <br /> 96 0 $,28 BMG0,2 g,t8 6 lG1S w9TER ASTiC -~ D ~C <br /> ~vn 7'~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER: ' aN Q SHIPMENT METHOD. AIRBILL NO <br />REQUIRED TURNAROUND' ~ SAME DAY ~ ~ 26 HOURS I ~ dB HUUR$ [ 172 HOURS C ~ 5 DAYS (I 10 DAY$ C I ROUTINE OTHER E E~P.9TLE <br />I. RELINOUISNED DATE ~h. ELI CUI$HED BY: ~ ~ DATE B~RELIA ISHED BY':~ DATE <br />SIGNAT <br />i 8~ / <br />A G $IGNATURE: SIGNATURE <br />PRIIIT NAMFJ O~Y ~ ~ ~ <br />M TIME ~ PRINTED NAMEICOMPANY: TIME PRINTED NAMEICOMPANY. TIME <br />I. RECEIVED BY DA 2. RECEIVED BY. DATE 3r RECEIVED'BY: DATE <br />ATU ~ $IGNATURE SIGNATURE: <br />PRIN D NAMEICOMPANY IME'~ PRINTED NAMEICOMPANY: TIME PRINTED NAME/COMPANY: TIME <br />RUSH TURNAROUND MAY REQUIRE SURCHARGE <br /> <br />^ AnpNim. Cnlilornu • ~uon I Omrnl. Calputln <br />1750 E Gme auur Wnr // 10107E Bel npnr 0nve <br />A~uM1nim. Glilplnu 91805 Auiorn, Caloudo 80016 <br />I111)97/~1096 170]1151 I1B0 <br /> <br />16001406 7617 G.IJ <br />180019177617 <br />^ Ldyn, WYOminp ^ Cprpn CM1rini, Tan <br />a70 Wen In Sven 1137 North htln I,Idntl 0rrve <br />G,Dn, Wrominp 87601 Lprpw [M1nni. Tun 18108 <br />170717755141 15171789~7fii7 <br />16001 fi66~0706 IBODI5688778 <br />^ Xpunan, Tm ^ LaYn CAnln, lpuanu <br />8710 Mp,lq Ppdtl 7645 Bgln P6rLNpr <br />Hou,mn,Tun 77015 fiWpnur. LOYnunp 1066] <br />111719679116 I71815B7a976 <br />160011 ]a~I677 18001759a976 <br />^ Lpnp 4sM1, Cnldequ <br />]100 Cnn~r Avenue <br />fang Bum, Gldomh 90801 <br />171015958a01 <br />18001 B1a li Jl <br />ORIGINAL <br />