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1;1199'~'~' <br />CORE LABORATORIES, INC. <br />No. 48313 <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION s .# <br />~ <br />~ <br />COMPANY / <br />L PROJECT NAMEMUMBER: ~ <br />4 <br />O ` <br />lM <br />SEND REPORT TO BILLING INFORMATION ~ <br />ADDRESS' 0 BILL Tp: <br />S N L. ADDRESS. LAB JOB NO. <br /> V <br />PHONE ~/ ~a ~ PXT, /S PHONE. <br />FAX: <br />719 6 7~ -33 6 3 <br />SMILE NO. SMILE DFS6i1Pf10N FAX PO Np.. <br /> <br />~D~p <br />Ca <br />\yy <br />O -:~r> .'~~ .~ ~A ..S <br /> 6 0 9/s r P R c ~.' s. <br /> cs FA' T d <br /> :/ A'e <br /> <br /> <br /> <br /> <br /> <br /> <br /> C 6 <br />~ <br />SAMPLER / SHIPMENT METHOD a~ <br />AIRBILL NO. 43a ~ 1 <br />REQUIRED 7URNAROUND:' SAME DAV 1d HOURS 14a NUUR$ I I77HWRS ISDAYS L ID DAYS ~vfRDUTINE OTHER <br />1. RELIKOUISHED BV: DATE .Z ~ DA7E 6YS " n » DATE <br />$IGNATUR 6 ~ SIGNATURE: SIGNATURE: <br />PRIIR NAMEIC V ~ /,/ <br />1. RECEIVED BP N <br />ATU TI E <br />DA <br />~ i/ p <br />J PRINTED NAMEICDAIPANY. <br />a <br />SIGNATURE: TIME <br />DATE PRINTED NNAE/COMPANY: <br />F: ' ~ <br />SIGNATURE: TIME <br />DATE <br />PRINTED NAMEICOMPANV TIME PRINTED NAMF1C01APANY: TIME PRINTED NAMEICOMPANY. TIME <br />RUSH TURNAROUND MAY REQUIRE SURCHARGE v <br /> <br />^ Aimnum Cditernia e ~unn IOnrm 1, Colonde ^ Ceyn, WYens, <br />1150 E. Gene Aui~y Way // 10107E annanv Dave 470 Wm In 9rm <br />A~mneim, Gidu~nm 91805 Aurera. Color4ao 90014 Grpm. Wyom~n11760I <br />111119711094 I707115LI180 17011775-SIN <br />1600140a.761] 16 001 911 161] IB001666U7116 <br />^ lien Chr~, ium <br />1777 Nenh Atlre Iabnd Drin <br />GrerN DMmi, TnH 1040e <br />81717097617 <br />lea6r w u:e <br />ARIf;INAI <br />^ Nrgr, hne ^ le4 CYrIm, Lrn.r, <br />x710 Me,M Nrd 7W5 Bqb, Perhmey <br />Naunon, T,ur 77076 Subhur, lounmrm ]0667 <br />D 1719479//6 171115611976 <br />19001774761] 06017594976 <br />^ Lml beoh, plilernb <br />7100 CnniY Avenue <br />long Bocn, GilAelnm 90801 <br />1]1015958401 <br />labor a 1.~].v <br />