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i; <br />~i~~F <br />CORE LABORATORIES, INC. <br />No. 48310 <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION ' ~'° ~'~ ~Ap~dEGT'IE~FOpMA71 •, .%;,'~ ~= .~ -` ~ ~ °' } <br />COMPANY - / 1 S <br />SEND REPORT TO' c~~~ ~ ,C <br />/ PROJECT NAMEMUMBER <br />BILLING INFORMATION "o-'~, <br />.Z~ yL Q <br />$ ~ a0\- ~Q <br />ADDRESS: <br />r ~ O / BILL T0: ~ ~~ ` <br />G ~. <br />Z@ a <br />O; <br /> <br />SAN ~u/ C ADDRESS: ~ <br />~ ~ ' <br />~ <br />LAB JOB NO. <br /> , D <br />~' ~ 6 2~ ~ <br />PHONE. 7/ ~ ~ - /~~ e ~ ~ <br />FA% 7IB 6 ~~- 3.36 PHONE <br />FA%. PO NO .'LG <br />~Z€ / ~ _\ ~[~ <br />•~', ~O ~`r rC <br />SMPLE NO. SAMPLE DESCRIPTION ORATE T~iMEE hl4~TR~X L17N1aINER TI'PE pRESERV. G ~ REMARKS /,PRECAUT,IONS <br />/ 96a9o Go / o9e 6 /oz/ w,~T~,e ~ T,' f zo, <br /> $ °!_ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER: K I ~ ./7O ~ SHIPMENT METHOD: AIRBILI NO . <br />REQUIRED TURNAROUND.' i SAME DAY ~ ~ 2a HOURS C 18 HOURS C 111 HOURS 15 DAYS I 110 DAYS C I ROUTINE OTHER <br />1. RELINQUISHED BY: ~ DATE ~1. RELINOUISXED BY: " ~ DATE J.~REL1flWISNED BY:. DATE <br />SIGNATURE <br />i ~ <br />0 $IGNATURE. SIGNATURE <br />PRINTED NA COMPANY - N ~ 4 T~.I~~O PRINTED NAMFJCOMPANY TIME PRINTED NAMFICOMPANV: TIME <br />1. RECEIVED B ~ DAT 2 RECENEA BY: DATE 7PRECEI D Yi ' DATE <br />T(1RE' <br />G SIGNATURE. SIGNATURE <br />PR1N ED NaMBCOMPANY: III PRINTED NAMFJCOMPANY: TIME PRINTED NAMFiCOMPANY TIME <br />RUSH TURNAROUND MAY REQUIRE SURCHARGE <br />^ Ambun. Gldornia °~I Aurpn IBanrarl, C°Ipnla <br />R50 E Ome Acorn WaY 10107 E. BnNnv Onre <br />Aiunum. G61omw 97605 Aurpn. Lnl°O6p BOOta <br />111 11971 I09< ^071 /51 ~I1B0 <br /> <br />180011011617 ~J <br />160019118617 <br />^c.an, wrpm;ng ^cgmm chnAl,rnn <br />CIO Wm in 51ree1 1177 NonN Patin Hbn6 Drive <br />G,pu. WYpminp 62601 Grew Lmin~. Tem 78x08 <br />1]0111]5 5141 151117691617 <br />180016660706 1800151 B 8118 <br />^ Npunpn, Tan ^ laha Charm, Lmnum <br />8710 Mo4ay Rw6 ]6A5 Bgln Bihwar <br />xounpn, Tam 11015 Sulphur, lnuniana 7066] <br />171719A7~9176 1]181581 A916 <br />16001771.1677 18001159]916 <br />^ Lang Baaah, Caldenn <br />J/00 L6env Annue <br />long Bn[h. Gl~lpmw 90801 <br />1]1015958101 <br />IeBm a 11 ]av <br />ORIGINAL <br />