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Client /Project Name: wc:-_ . i.Zt , , 1 i fii,, t,s L09. <br />applicable) <br />P.O. /Project Number: <br />WET: Acute (indicate Below) <br />WET: Chronic (Indicate Below) <br />WET: Accelerated (Indicate Below) <br />WET: PTI /TIE /TRE (Indicate Below) <br />Metals (List Below) <br />Solids (TS /TDS/TSS) (Circle) <br />Anions (List Below) <br />Chromium III /VI (Circle) <br />aseaJD pue 110 <br />Coliform (Total /Fecal /E -Coli) (Circle) 1 <br />BOD /COD (Circle) <br />Other Analysis (List Below) <br />Number of Containers <br />Total Volume <br />Contact: — 5 - : :v..... _ ( <br />Address: 274 NA-) S IJu , CO 314z-4 <br />Phone # 170 86 4 7.510 <br />E -Mail: T 06tb <br />Sampler: 1 t s F- <br />Fax # 4 70 564 St Lg <br />Report By: ❑ Mail ' DF EJ FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(LAB Use Only) <br />/U ‘? Or s " - <br />(G.101 <br />+a3-a--. <br />t c o <br />_ _` <br />.�-. -- <br />' t411 '3..-..11_ <br />✓ <br />2 <br />6,ka- <br />T vvy I3 L.A3 *‘ <br />l <br />t LS. <br />Turnaround ltequIrernen is <br />(Analvticai Testing OnM ' <br />Test Species: thead Minnow eriodaphnia ❑ Daphnia magna ❑ Daphnia pulex ❑ Other (List Below) <br />Standard (10 <br />days) <br />6 Day <br />1 -2 Day <br />Special Instructions /Comments: <br />3 -5 Day <br />Requested Report Date: <br />Relinquished -By (1) . <br />Recelved B y (�.�: <br />Retlnqulshed sy (��. <br />Received.By (} ;• <br />Signature <br />Date/Time <br />10.3•11 <br />Signature <br />Date /Time <br />t✓ <br />Signature <br />Date /Time <br />Signature <br />Date/Time <br />tcoCre,tGrou <br />A N C N V I P O N M E N T A L Sr N V I C C .. C O M A N V P P <br />CHAIN OF <br />STOCUDY <br />1341 Cannon Stree Ile, CO 80027 <br />(303) 661.932 4 - FAX (303) 661.9325 <br />