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N° 100y5 <br />'~,~ <br />CORE LABORATORIES <br />r ~m '~~:I Analysis Request and Chain of Custody Record ` <br />"-'"^^ 1300 S. POTOMAC,SUITE 130 <br />AURORA, CO 80012 1303) 751.1780 <br />Project No. Client/Project Name Project Location <br />S <br />.SLgv i3~n~z MT.v Go~.~ ~ <br />~rJ L"S <br />Lab Field Dete n Sample Sample <br />ID Sample No. and m E <br />U Container <br />' Type (Liquid Preser- <br />vative <br />ANALYSIS REQUESTED LABORATORY <br />REMARKS <br />No. Identilicetion Time C~ ISizel Mat <br />l) Sludge, Etc.l <br />1 9zloz~BMG lo/t~/9z <br />X sw•m~- <br />W Ale t- <br />Ft uo. <br />'~; c <br /> <br />°1 <br />9o <br />Pc , <br />~ . <br />~-~`c~.~eD M e.lnts <br /> i~ +.v <br />lz <br />P tr <br />ANC <br />! <br />Gh <br />h <br /> ) <br />r - n;~ ;.o <br />ewt <br /> sr F ! <br />~ <br /> p .: <br />Yi C)e <br /> a 10(9A 'rvs{ HL.X~ <br /> <br /> rt <br />r ~n m.l <br />G.~ u <br />Efz, Y <br />TG C ~1 ~ ..ti O r- ~,r3. <br /> rr loon mi <br /> .. <br />P~ <br />'' <br />~ <br />.A'c~~ N <br /> . r s ICr~ ~7nt ~. <br /> <br /> <br /> <br />Samplers: /Siyneturol Relinquished by: n Date : . rf 2Q jr~s Z Received by: Date: COC Seal No. <br /> lSignetu ~ - T'I" <br />,~./ C ~ t <br />Time: a..;C, /Signature/ <br />Time: <br /> Relinquis ed by: Date : Received by: Dau: <br />AI(iliation lSignaNrel <br />Time: lSigneturol <br />Time: <br />P-~S/(~ ~ ~ ~, Relinquished by: Date : Received by Laboratory: Datejp.~)~tact: <br /> lSipnaturel <br />Time: /Signature <br />~h 1 , ` <br />Time: ~ <br />REMARKS: Data Results To: INamalAdtlressl Laboratory No. <br />^~ <br />1:.~T$ 7c, i-~,gG~.4~e <br />A ~+ <br />+GL <br />¢SSc~c 1~ .9. SCOT £,~3 •NG] <br />. . <br />. <br /> 7 ~rcf _ <br />3 ~' 2. ~ to?P~r~ ~NALli P <br />1 <br />S[ 4SS ~~~~ <br /> YS <br />. . <br />. <br />~ ~ cc <br /> <br />C.~- <br />w <br />ti <br />White -Return With Results OI Analysis Yellow -Lab Copy Pink -Samples Copy <br />