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Client /Project Name: kkp =,jth L «y <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 />lAnions (List Below) <br />Chromium III /VI (Circle) <br />Oil and Grease <br />Coliform (Total /Fecal /E -Coli) (Circle) <br />BOD /COD (Circle) <br />(mola8 }sly) sisAieuy JaylO <br />Number of Containers <br />Total Volume <br />Address: .7 G fi t, ��4i f a� c•t..F�� C (�. <br />„ <br />Report By: ❑ Mail DF ❑ FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Com <br />Lab ID <br />nARu oNV <br />l � '°- <br />[f:>µ <br />11'(t`>1 <br />" ?ir- <br />\\ <br />Turnaround Requirements <br />(Analvtical Testink Qrdv5 ' <br />Test Species: athead Minnow�Ceriodaphnia J Daphnia magna ❑ Daphnia pulex ❑ Other (List Below) <br />Standard (10 <br />days) <br />6-9 Day <br />1 -2 Day <br />Special Instructions /Comments: <br />3 -5 Day <br />Requested Report Date: <br />Retie wished By i1) <br />Rec . <br />eiired By,( <br />Relinquishad r?iy f21" ... •, .: <br />Received By (2) , • • <br />Signature <br />--- <br />Date/Time <br />to, St It <br />Signature , <br />/ <br />Date /Time <br />4., . <br />Signature <br />Date /Time <br />Signature <br />Date/Time <br />t i ccC!c1tGrou <br />CHAIN OF CUSTODY <br />1341 Cannon Street Louisville, CO 80027 <br />(303) 6619324 - FAX (303) 661.9325 <br />