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N° 10099 <br />'~,' <br />CORE LABORATORIES j <br />11n°te:~;"er o ei Analysis Request and Chain of Custody Record <br />"'""'~"^ 1300 S. POTOMAC, SUITE 130 <br />AURORA, CO 80012 1303) 751 -1780 <br />Project No. ~ Client/ <br />Pr <br />oject Name Project Location <br />s2rfi~~ c <br />~ <br />/ <br />b~-fC~[.P MT. `1o~D 57,..1 Lu,S <br />Leb <br />ID Field <br />Sampla No. Date <br />and <br />n p <br />E Semple <br />Container Sample <br />T <br />ype lLiquid <br />Preset- <br /> <br />ANALYSIS REQUESTED <br />LABORATORY <br /> <br />No. <br />Itlentification <br />Time <br />O <br />U <br />(Size/Ma['ll <br />Sludge, Etc.) va[ive REMARKS <br /> c1G •O C6 (~> IG/L6~rfG K C~IL Pc' tA1f~LL'C II+c+S <br /> of l 30 '~v n/~,c>.r <br /> ~.'T PPLi C.i '~o q.11 SAm Pres'nE' <br />/_ y z ~ 02 S3 v,6 / `rze%t M CZ) IL Pc ' t <br />r <br />~ <br />T <br />\ <br />J <br />, <br />C N ~ <br />lp ~oH 11R. r <br />o <br />n <br />>Qb <br />, <br /> <br /> <br /> ~I Llote.l?•.s(, <br />O roi r.!/qL <br />X <br />(z~ 1 /- et . <br />r µ""; SOa, urn <br /> r Nrt (:H <br /> <br />~5 92to26 (3~+6 1O/~7Z x (Zl IL Pc it Hr+oJ <br />O OS iSr ` vc nH <br /> `I Lto ZU tiu~ to/Cr;/qZ (Z~ IL Pc r, >~rous <br /> oG t5oo x l N4oH <br /> QLICI ZC 3M1. to/z619Z r r N^}O, <br /> <br /> <br />Samplers: ISipneturel Relinquishpd7~y: <br />(' <br />e Date: Id~LN/r/L Received 6y: Date: COC Seal No. <br /> ry <br />-_ <br />!Si naturl76( , <br />p ...1 Mlt,.vr -l/ ~ <br />Time: 10~ (Si natural <br />p <br />Time: <br /> Relinquished by: Date: Received by: Date: <br /> <br />Affiliation /Signature) <br />Time: (Signature) <br />Time: <br />NA(,tPR51eA ~ oC. Ralinquishetlby: <br />lSi Date: Received byLa6oretory: <br />lSi <br />t <br />l Dere:jO.Zg,~lntact: <br /> gnerurel Time: ure <br />gne <br />L'.hl Time: (71 ~~ <br />REMARKS: Data Results To: INeme/Address) Labaretory No. <br />il.t S ' i C N A]~pf*tk A ~- f+S AUG <br />~ <br />l <br />~ ~'L t. A. ScoT ~ R.M(~~ <br />q <br />. <br />. <br />- <br /> ~l ~~9 <br />~ ~~ 9~ _ 3 z y s z. n . T,sP~ ~ ,-J,uc~aSr~,l + .q,s ~u- <br />F <br />~- <br />f_a. <br />White -Return Wirh Results Of Analysis Yellow -Lab Copy Pink -Samples Copy <br />