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Cemex Alternate billing information: ti a Chain of Custody <br />5134 Ute Hwy Lyons, CO 80540 I Page _J_ of 1_ <br />Prepared by: <br />ENVIRONMENTAL <br />SCIENCE CORP <br /> sport to: . <br />12065 Lebanon Road <br /> maid m: <br />monica.sowders@cemex.com <br />" <br />r Mt. Juliet, TN 37122 <br />Project <br />Description: City/Sate <br />Collected <br />Phone (615) 758-5858 <br />Phone: <br />FAX. (303)-823-2115 Client Project #: ESC Key: Phone (800) 767-5859 <br />FAX (615) 758-5859 <br />Collected byMonica Sowders Site/Facility ID#: P.O.#: <br /> <br />Collected by (signature): Rush? ( Lab MUST Be Noted) <br />Same Day....... 200% Date Results Needed: <br />No. CoCode (lab use only) <br /> <br /> <br /> <br />acked on Ice N Y <br />Next Day........ 100% <br />Two Day .........50% <br />Email? _No_Yes <br /> <br />FAX? -No-Yes <br /> <br />of <br />J <br /> <br />y?? U Template/Prelogin <br /> <br />Sample ID <br />Comp/Grab <br />Matrix' <br />Depth <br />Date <br />Time Cntrs <br />l j Shipped Via - <br />Remarks/Contaminant Sample # (lab only) <br />N P Dt-, S t'tD <br /> <br />N PD D C*''' t? <br /> <br />QY^b <br />- QT SW <br /> <br />St4 r 10/101ft <br /> <br />ro G <br />yUcr <br />4 fp" <br /> <br />1 <br />_ T <br />-b <br /> <br /> <br />12 C' R_A - <br />C- <br />pi f <br /> <br />Grr„lo <br /> <br />SS <br /> <br />$wrw <br />W GK_ <br />G- eif- KC4 8 Cas4xbl Carib <br /> <br /> <br /> <br /> <br /> I <br /> <br />'Matrix SS- Soil/Solid GW- Groundwater WW - WasteWater DW - Drinking Water OT-Other _ _ pH Temp <br />Remarks: ? 9 ZS &l 2/ ) t. 4n <br />Flow Other <br />Relinquished by: (Signatures Dat : <br />41 Time: <br />VP04-11 Received by: (Signature) <br />1 Samples returned via: E] UPS <br />LE FedEx ? Courier ? __ _ Condition:' (lab use only) <br />Relinquished by: (S' , <br />.» Date: Time: Received b Si natu <br />Y: (g <br />Tem <br />Bottles R ived: <br /> <br /> <br />Relinquished by: ( )? Date: Time: Red ' for lab, b Mature) Date: Tim pH Checked. NC F: <br />