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<br />CORE LABORATORIES, INC. <br />No. 4~3 /51 <br />CHAIN OF CUSTODY RECORD <br />• ;;~.r; ~ ~ CUSTOMER ~NFOAMAT~O ~ ~;~ ~' <br />~ o <br />COMPANY: ~ <br />~ PRO7ECf NAYEMIA03Elt ~ <br />,~~ <br />SEND REPORT TO' ~ ~ ~ BIWNG INFORNAiION <br />ADDRESS D &LL TO: ., <br /> <br />1 . <br /> ADDRESS: <br />LAB JOB NO. <br />t <br /> <br />PHONE <br />"' o~ <br />~ <br />q~i8~9 <br />_ <br />: ~ /_ <br />)~ <br />1S <br />~ PHONE. . <br />~1. <br />Il <br />K <br />~ <br />~ <br />_ ~ <br />FA% FAX PO NO.: <br />SMILE NO. SAAWLE DESCNIFTION ~ '•.'>'x ~.:.,°v'r.l.~, <br /> <br /> <br /> - ~5 WGtt ho~~ fr~~-re <br /> brf. a-e r er~r~( . <br /> 5. a~5er a~xl <br /> °~- f AS o'Pa~S- <br /> <br /> <br /> <br /> <br /> <br />SAMPLER: ~'` L7ti ~~ Ci SRIPYENf YE1HOD: ~ AIRBILL NO: <br />REQUIRED TURNAROUND.' ~ ~ SAME DAY I J 2d HOURS ^ /B HOURS ^ 72 HOURS' ^ 5 DAYS' ' • ^ 10 DAYS' ^ HOUDNE ~ ~ OTHER <br />1. RE1W01115HED SY: = y i TE DATE ~ DATE <br />~ <br />T E: <br />7~ <br />' <br />61(>t1AT1YE ~ ~ ~ SIGNATURE: <br />~' <br />1 ~ <br />`. <br />D NAA~/COYPANY: \ ~y 1 <br />J L9./~kJ .~~ PROIIFD NAYEA.OI~WANY: TIME PRINTED NAYEICOh1PANV: TIME <br />a . <br />1. RECENEO RYi DATE DATE DATE <br />TU ~~ SIfl1ATUlE ~ 'SIGNATURE: <br />PRINTED AMEIC MPANY I E ~ PRNTED NAY6CONPANY: TIME PRINTED NAMECOMPANY' TIME <br />RUSH TURNAROUND MAV REQUIRE SURLHAR <br />^ An.n.im, uul.rni. • nrur. ID.n..l, cvnr,i. <br />1790 E. Gene 4unr wrY 7 E. en MnY Dnw <br />Anne~m, hl,lo~nn 97905 Auio . [OlOrndO B091d <br />171/1971 1091 17071151 1160 <br />19001 101 7 6)l 19001917 7677 <br />^Cnnlr. Fvnie ^C~,v.OWVl,ian <br />170 Yal Iv Sh,n 17]7 NMh A6n IbnO Driv, <br />vu®I <br />E T,nu 7910! <br />I <br />.U~ 75d711 5111119;e77 <br />0001668L6 16001 fiN8771 <br />^ Nw~, hna ^ bb CYrrly, Lr.eiuau <br />R10 Ye1W ReW 7W6 eyln hrk.aY <br />Hauvsn, T,va 17076 9epnur. Leuabnn 1066] <br />OI719178116 171116171976 <br />U1WI771~7617 Y001 7 6919 7 6 <br />^ Lsn, en.n, GGlnrnb <br />7100 CneriY Avenue <br />lonq 9wcn, Ulllerni. 99991 <br />17101 69 9 8111 <br />I9/011117r37 <br />ORIGINAL <br />