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.1,~~""`~I <br />CORE LABORATORIES, INC. <br />No. 48754 <br />CHAIN OF CUSTODY RECORD <br />b <br />'` " 'CUSTOMER INFORMATION ? ' ;3~-R <br />~ I F ?,I. ~" , <br />COMPANY. <br />_ PROJECT NAMEMUMBER <br />~ <br />~ <br />SEND REPORT TOL+ I l <br />~~L LI.LS C1~ BILLING INFORMATION C ~ <br />ADDRESS <br />D BILL T0: " <br />'V! 12 <br /> <br />. S ~~~ <br />ADDRESS <br />: <br />LL , w <br />LAB JOB NO. <br />PHON ~ _ ~ ~ PHONE ^,~~s <br />v ~ ~ <br />O ~~~~ <br /> (~ . ~ <br /> <br />SAMPLE NO. <br />SAMPLE DESCRIPTION <br /> <br />A <br /> <br />R <br />*"` I <br />ls' <br />~ <br />L~: <br />LE <br />.. 1 <br /> <br />mNTA 71Efl 7YP <br /> <br />;AR~ESERA <br />e ~ J <br />p p (~e1 ~' <br />:. I~ RICSEI~'!:'EcTU`4'1~ ~,c <br />I I ~ ~ (~ G .310 ~r Le. ° k-{! <br />a ~~ t ~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />SAMPLE ~ _ ~ ~~ SHIPMENT METHOD ~ AIRBILL NO.: <br />REQUIRED TURNAROUND:' <br />1. RELIN'OUISHED BY: <br />AT ] SAME DAY I ] 2/HOURS <br />"' ~~ <br />~~ ^ IB HOURS <br />DA <br />~ I / <br />V " ^ 73 HOURS ^ 5 DAYS ^ 10 DAYS ^ ROUTINE <br />ELIN E + x 3 - b' DATE <br />61GNATURE. ~ OTHER <br />~ DATE <br />SIGNATURE: <br />PR NAME/C Y_ I _ •_ ~ <br />~,(~~ r7' ' <br />TI E; <br />J 'PRINTED NAME/COMPANY: TIME PRINTED NAMEICOMPANY. TWE <br />1. RECEIVED BY: DA E ECEIVED flY: ~ F f :: Sl : Y ; r t . DATE 4 DATE <br />URE:~ 7/ 7 rJ/ <br />71o SIGNATURE: SIGNATURE: <br />PRINTED N FJCOMPANY ~~ IME PRINTED NAME/COMPANY TIME PRINTED NAME/COMPANY: TIME <br />RUSK TURNAROUND MAY REQUIRE R <br />SURC <br />H <br />A <br />GE <br />^ Awbim C,hlpmn . <br />r <br />~ <br />{ <br />)t•.LI Auran (~mrnl. Colenle <br />1750 E. Gene Amw W+r , ` 10107 E.6nhgnr Onv, <br />Aruae~m, C+Iitp~nJ 91605 qurpn, [alpntlp 60011 <br />11111971 ~ 1091 170]1 151 1160 <br />16001/0/ ~7 fi17 16001977 ~7fi17 <br />^ h4m. WYnmial ^ Csrpu CariM1i, Tnn <br />170 Wnn In Soul 1777 Mona Btln Id+nO Oxve <br />Opn, Wrammq 67601 Cprpu Chnni,Tnn 16106 <br />'170117355111 151717997613 <br />I/OOI 6fi6070fi 160 01 51/6 3 7 6 <br />^ Hwrtpn, Tum ^ 4b CYmY+, Lwe~n <br />6310 MO,lq, Rp+tl 7WS ogle pYremnr <br />Noonan. Tnap )1615 $uyhur, Lauubru 70667 <br />111319179716 171615/]]976 <br />180011713677 16001759]976 <br />^ 7100 Gary Awnu~ <br />Lenp Ewan, C+Iilornu 90601 <br />^101595dW 1 <br />16001 /11du17 <br />ORIGINAL <br />