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~!~.Vy <br />CORE LABORATORIES, INC. <br />No. 48314 <br />CHAIN OF CUSTODY RECORD <br />CUSTOMER INFORMATION ~ ~ ' `PROJ .(;T INFOFjM14T10N ~ ` " :: ~ ~ ,x ~ O'! ~ ' <br />~ i <br />COMPANY N ~~/~ PROIECi NAMFMUMBER e = e(; <br />~ <br />O <br />~ 4,\\~ a O O~ O <br />SEND REPORT TO fLC fZ BILLING INFORMATION y¢j~ <br />~ P <br />~ <br />"~- \e a 0 `~ <br />f <br /> <br /> <br />ADDRESS' <br />d <br />U ~ O <br />a <br /> <br />BILL T0. <br /> <br />~ e <br />1 \\p <br />\ <br />\ ~` <br />~1 <br /> D' O // ~ ADDRESS ti <br />y~ LAB JOB NO. <br /> ? , ~ ~~ <br />PHONE: ~`~ <br />7i9 ~ ~ /~ ` X r /~ <br />G 7z-3,363 PHONE ~~ }~ ~ y <br />` f.` ~ <br />SAMPLE ND SAMPLE DE$CR IPTION ~ATEE SMMEE ~ R~X OOMAINEfl TYPE PRESERV. `~• \ 4~ ~ REMARKS !PRECAUTIONS <br />/ 96~aa~B.,+Go~ e osr o9~o w rE slc t ! I I <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLER SHIPMENT METN00: AIRBILL N0. <br /> <br />REQUIRED TURNAROUND' ~ ~ SAME DAY ~ I 2a HOURS <br />L. 148 HOURS n <br />LI 7I HOURS ~ ~ 5 DAYS LI 10 DAV$ ^ ROUTINE OTHER /LN SH RC <br />SL! I T S <br />I. RELINQUISHED BY. DATE ~'t. ELINOUISHED B : DATE 3; RELINQUISHED BY: DATE <br />SIGNATURE ~ ~a/Op <br />j G SIGNATURE: SIGNATURE <br />PR0ITED NA COMP ~^ ~" <br />N TIOME PRINTED NAMEICOMPANY: TIME PRINTED NAME~OMPANY TIME <br />1 ECEIVED BY DAT .RECEIVED BY.~' ,'. - +, s DATE J. RECEIYEO~B - DATE <br />I TORE i SIGNATURE: SIGNATURE: <br />PRIN D NAMEICOMPANV' ~ E oO PRINTED NAMFICOMPANY TIME PRIMED NAMF/COMPANY. TIME <br />RUSH TURNAROUND MAY REQUIRE SURCHARGE <br />^ Anabim, G61a~nu ~AUrpn IOmrn 1. LalprMa <br />R50 E. Gene Auvy Wav 10107E Bn6anv Onre <br />ANhum. Gldnrnia 97605 Awpn. Colorado 6001E <br />111/1971 1091 17071151 1180 <br />(8001401 7617 18001917 761] <br />^ Caapu, Wvpmin9 ^ Cnym Cmini, Tlm <br />110 Wen In Sven V 77 Npn6 Patin Itland Orwe <br />Gaper, WVpminp 87601 Cprpm Chrmi.Lw lBdUd <br />170117JS~S11I 151717895617 <br />1800166fi~070fi 180015x88776 <br />^ Naurtan, Tun ^ 4b CBVIn, leunnna <br />BIIO Mptlq Ppad ]615 8pha Pu Ywav <br />Npunon, Tew 17015 9YIphY(. LOYpgna/066] <br />1117191]9116 1]161587x976 <br />1~00173A5671 18001159 J976 <br />^ len, Ba.4 CaLbmia <br />7100 Lnr~ry Avenue <br />Lpnq BnoB. Gl~lpmu 90601 <br />1]1015958101 <br />18001 B1 a.].]7 <br />ORIGINAL <br />