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Client /Project Name: V)FSTF -UF_.LS COL u -Art <br />applicable) <br />/i?//t-3 <br />P.O. /Project Number: ki e,v) r'Z.ON M 1.11 <br />t,1 <br />[ 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 />Coliform (Total /Fecal /E -Coli) (Circle) <br />BOD /COD (Circle) <br />Other Analysis (List Below) <br />FT" <br />"'Number of Containers <br />C' Total Volume <br />Contact: ()v' <br />Address: 27 L. 44- t/V 55 0 - 4 .Jc /J (JCtj4- , L) <br />4 Phone # q70 $L 4 7.5"go <br />E -Mail: T <br />Sampler: ,— <br />Fax # 9 70 24. 4 1.1 LB <br />Report By: I_.J Mail ' Vr EJ FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />I Use Only) <br />KR WS fl11 <br />S, 17.12. <br />I I a <br />U <br />; n11 o <br />8� <br />a <br />Turnaround Requirements <br />(Analytical Testing dnlvl - <br />Test Species: Fathead Minnow Ceriodaphnia ❑ Daphnia magna ® Daphnia pulex ❑ Other (List Below) <br />Standard (10 days) 6 9 Day <br />_ <br />Special Instructions /Comments: <br />3 -5 Day 1 -2 Day <br />Requested Report Date: <br />fis hed By (1) <br />Received By (1) <br />Relinquishad By O 1 eceived B <br />Signature <br />.x.110'" <br />P <br />Date/Tim ( <br />li`'` <br />° •ature <br />"�y, <br />Date /Time <br />Signature <br />Date /Time Si: <br />�4 <br />a ' ' <br />�. ,k-, t,. <br />�....- <br />Date /Time <br />c�, StG <br />SeoCrestGrou <br />2N lNVeRf NUrMSa∎ CF R'Jf■ S4 YnNaYNY <br />CHAIN OF CUSTODY <br />Cannon Street Ile, CO 80027 <br />(303) 661.932 03) 661.9325 <br />