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a <br />i;~~~;~~W~~ <br />CORE LABORATORIES, INC. <br />No. 48750 <br />CHAIN OF CUSTODY RECORD <br />'" CUSTOMER INFORMATION '` sa, ?~ '°' <br />COMPANY: ~ <br /> <br />SEND REPORT r . <br /> <br /> <br />~ PROIECTNAMFINUMBER: <br /> <br />BILLING INFORMATION M <br />Q <br />ADDRESS' ~ I V <br />V BILL T0: ~ `- <br />~[~ <br /> I~C~ <br />l <br />J ADDRESS. ~ LAB JOB.NO. <br /> <br />PHON : ~ 1 ~~ <br />l <br />FAX ^ _ ~ I~ ~ <br />. <br />? <br />J ~ PHONE' <br /> <br />FA%: <br /> <br />PO NO : <br />O <br />~ (/~ <br /> <br />- Q ~ • <br /> <br />SMiPLE NO <br />SAMPLE DESCRIPTION ~~ <br />DATE e~,pLE <br />TIME, SMILE <br />TAI%~. <br />R7NfAINER 9PE <br />PHESEFAVa. <br />£ ~ ~~~ <br />RE ARKS,/fPREC/,~_ T S <br /> ~ `~t3m , ~ G s ~~ 1 l -la 3 ° <br />a o3 al ' ~ 1 l l I`L-9 sZrS~°r <br /> G I n- x <br /> 0 S" l n - <br /> <br /> <br /> <br /> <br /> <br /> <br />$AMP ~/ ~ (J ~ ~~ _ neZ~ SHIPMENT METHOD: AIRBILL NO. <br />REQUIRED TURNAROUND' I I SAME DAY I f 74 HOURS ^ 4B HOURS ^ M HOURS U 5 DAYS ^ ID DAYS ^ ROUTINE OTHER <br />t RELINQUISHED BY: ! D E ELINWISHEIYB : >- ~ ~ ° •' ~ DATE E SHED r "' DATE <br />IGN T 1 <br />I ~~~ SIGNATURE: SIGNATURE: <br />ED NA ICOMPANV~ ~ <br />i <br />1.flECEIVE BN <br />ATU S <br /> <br />i t I F, 3~ <br /> <br />DA E <br /> <br />YO - PRINTED NAME/COMPANY <br /> <br />RECEIVED BY:"' :9J: <br />=SIGNATURE: <br /> <br />.3-= n:+ TIME <br /> <br />DATE PRINTED NAMFJCpAPANV <br /> <br />-F L `-~ <br />SIGNATURE: <br />' TIME <br /> <br />DATE <br />PRMT D NAMEICOMPANV ME PRINTED NAMEICOMPANY: TIME PRINTED NAME/COMPANY. TIME <br />HUSH IUHNAHUUNU MAY HEUUIHE SUHCHAH <br />^ AnaNUm. Calderon a ten IOanml, Lolentlo <br />1150 E Gene Amer Way 1010] E. BHbny Oure <br />An.nnm. Lanlomn 97805 Aurora, ColDntlo BOOu <br />11111 9 71 10 9 4 I7D71 )51 ~I160 <br />16001104161] 1600191776)] <br />^ Latpn, WYOminl ^ Cerpur Lfiriwl, Taan <br />410 Wm M1I Suan 1777 Nonn Ran Itlantl Drrve <br />G,Der, WVOmmD 678[1 Lorpw L61nII,Tnn16406 <br />170717355141 15111769 7617 <br />Ifi0016fifi~070fi 190 01 516 4117 6 <br />^ Nauwsn. Taa ^ Lab CNnYa, Leuniana <br />6710 Mo,lry BDatl 76x5 fiagli, Parkway <br />Moulton, Tun 11015 6uIDDYf, Loununa 1066] <br />171719479116 I7161567J97fi <br />16001174 7617 16001759 <91fi <br />^ Lana 9anN, CMdemu <br />7100 Long Avenue <br />Long fieacn, Calilornn 90601 <br />17101595E401 <br />IB001 B I4.]4]] <br />ORIGINAL <br />