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N° 10096 <br />' ` <br />,',' CORE LABORATORIES <br />~ ~,` e' o si Analysis Request and Chain of Custody Record <br />""°'~"^" 13005. POTOMAC, SUITE 130 <br />AURORA, CO 80012 (3031751-1780 <br />Project No. Client/Project Name <br />~ Project Location <br />S <br />~ <br />5z~-r ~~m~ .~~ G~~~ ~>v <br />.,,s <br />Lab <br />ID Field <br />Sam 19 No. <br />P Date <br />and <br />n n <br />E <br />o Semple <br />Container Semple <br />T e (Li uid <br />YP q <br />Preset- <br />vati <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br />REMARKS <br />No. Itlantilicetion Time t7 U (Size/Mat'll Sludge, Etc,) va <br /> yLIOZ78M6 1O~L7~92 <br />X Sot++nt <br />, <br />. <br />WnirrR <br />NNC, <br />jl <br />. <br /> U.t ~ <br />~ 3 i ~sot....eo M~Tdc~ <br /> ., d 'L-1R Pa t. Nuc, <br />~1~P.oC~ <br /> s e.m <br /> <br />, . <br />,y LSo *+l <br />R <br />r. <br />~wtc.~ ~+ <br />5~,~ * ~r~ ~' <br /> V /' ~ G[ ,1 N~So <br />d~L•r- ~~' <br /> e4S <br /> . t r ~ SCU L ` s l HL.SO . ~ LAC <br />N ~.~ ~ <br />U u <br />/V"-i <br /> . <br />l <br />. <br /> <br />r ,. ~ 1 A p~ n ~O.V /.n.¢S'~,(Z .~N~O.vS <br /> .. •• ~ ~ 2 per= v,,~k C ti T~r~ +- W AD <br /> <br /> <br /> <br />Samplers: ISignsturoJ Ralinqui by: Data: tW 2 t+rrr 2 Received by: Date: COC Seal No. <br /> (Signet ~ Time: IU , n !Signature) Time: <br />-- Ralinqui ed by: Date: Received by: Date: <br />Affltletlon ISipoatur~ <br />Time: (Signature! <br />Time: <br />1~11L~P~~Q t., ~l~K Relinquished by: Date: Received by Laboratory: <br />ISi Date{Q.~. tact: <br /> ISignerurel <br />Time: gnaturel <br />Cfl 4SYY~ <br />Time: ~(~~ t <br />REMARKS: Data Results To: (Name/Address) Laboratory No. <br />~~~ ~es~~~s To gnu--}~asi~>~ ~ fKScc. t~ A.g~,>~r G3MGJ <br /> / <br />~ <br /> ( <br />~ <br />( <br />~ <br />7 t./`~ -03 zy~ A <br />2. ~ '~C~Q ('~C ~ ~!11~=t'>?S IC Il ~r "hS.S~S . <br />~~ <br />` <br />/1. 'I <br />White -Return With Results Ot Analysis Yellow -Leh Copy Pink -Samples Copy <br />