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Client /Project Name: '�':�y7( S4j $, <br />applicable) <br />P.O. /Project Number: K14.0.) 14°' ' ►V1TIV�Q <br />1 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 />Oil and Grease <br />[Conforrn (Total /Fecal /E -Coli) (Circle) <br />BOD /COD (Circle) <br />[Other Analysis (List Below) <br />Number of Containers <br />Total Volume <br />Contact: <br />Address: 1-70(4. \A, rV+i�u�- C <br />Phone# q' tO &oi 75 <br />E -Mail: TFay9 0 . 1 i" - C4JUGLA -,0,.1 <br />Fax # rt'o WA 2 <br />Sampler: <br />i <br />i =(:.,� <br />Report By: ❑Mail F <br />t <br />FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(WI Use Onw) <br />‘ l <br />g<<S.(L <br />111 <br />G <br />S1n <br />--- <br />G <br />Turnaround Requirements <br />(Analytical Testing Oni <br />Test Species: ® Fathead Minnow Ceriodaphnia ❑ 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 />Relinquished By (1) <br />Received By (1) <br />Relinquished By (2) . <br />` . Received By (2) <br />Signatur <br />Date /Time <br />Signature <br />Date /Time <br />Signature <br />Date /Time <br />S at e <br />Date/Time <br />icoCreitGrou <br />AN I VINy C41" , .6N1ICC+. fGNISNV P <br />CHAIN OF CUSTODY <br />Cannon Street Ile, CO 80027 <br />(303) 661.932 03) 661.9325 <br />