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Client /Project Name: .k}'� S'IF� LS COLI <br />applicable) <br />P.O. /Project Number: IV Qvo 140(Z 1k/k,\r-z_ <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) 1 <br />Anions (List Below) <br />Chromium III /VI (Circle) <br />Oil and Grease <br />Coliform (Total /Fecal /E -Coli) (Circle) <br />BOD /COD (Circle) <br />Other Analysis (List Below) <br />Number of Containers <br />Total Volume <br />Contact: .(0,t,,, -F—ik./ <br />Address: 176 4(, lNS'r AIJT /UU ,..L.A.- Co g 1914 <br />Phone # 9 70 a' ,4 75 <br />� <br />E -Mail: l PRYQ.. VJT= L}1UCLA—",pR(; <br />Fax #,70 g , f 244 <br />Sampler: k Fy <br />Report By: ❑ Mail 11 FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(LAB Ike U4i <br />1`I ?�zs 0 fk <br />9. 13 12 <br />01 <br />G <br />' . <br />►�- <br />Z. <br />G <br />ie_v.1 BNgic, <br />1 <br />In.. <br />Turnaround Requirements <br />(Analytical Testinx Only) <br />Test Species: ❑ Fathead Minnow Ceriodaphnia ❑ Daphnia magna <br />Daphnia pulex ❑ Other (List Below) <br />t <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 />Relinquished By (1) <br />Received By (1) <br />Relinquished By (2) <br />Received By (2) <br />Signature <br />Date /Time <br />signature <br />Date /Time <br />Signature <br />Date/Time <br />Signature <br />Date/Time <br />� eaCrestGr0u <br />CHAIN OF CUSTODY <br />1341 Cannon S usville, CO 80027 <br />(303) 661. FAX (303) 661.9325- <br />