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<br />Client/Project Narne: V., IT:5, - , - '1;ii..K l' „ ,,, ( (., L.L'A:,:\ L L.
<br />Analysis (Check all applicable)
<br />P.O./Project Nurnber: j,... k lic4 Ink,
<br />Vv'cT: 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 />aseaJg pue lio
<br />Coliform (Total /Fecal /E -Coli) (Circle)
<br />BOD /COD (Circle)
<br />(Other Analysis (List Below)
<br />Number of Containers
<br />awnloA le ;ol
<br />Contact: 1
<br />Address: - 1 /L. 4 1,.., (, .. ' let /: v17, A), ,, ■A-- Co C (4 Lei
<br />Phone # '-, '70 4 ; 1','4, 4 ?.t51c
<br />E-Mail:
<br />Fax # ` - - 7 Sd 2?
<br />Sampler:
<br />L,
<br />Report By: Mail -PDF Q FAX /
<br />Sample Location or ID
<br />Date
<br />Time
<br />Grab/
<br />Comp
<br />Lab ID
<br />,LAB Use Only,
<br />lc '41 s \ 2 -
<br />10
<br />I
<br />E
<br />" ',Tn ^ 11,:vv,...:
<br />W l,,Oid a 1,,
<br />*2-
<br />:fl X 2 _
<br />. •-
<br />.
<br />7"1. VV‘V) '',.,A
<br />',■
<br />kao
<br />\\
<br />' Turnaround Requirements
<br />(Analytical Testing Only)
<br />Test Species: J Fathead Minnow Deeriodaphnia 1Daphnia magna
<br />Daphnia pulex
<br />Other (List Below)
<br />R
<br />II
<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 />Rer v i: Al
<br />Received By (1) , .
<br />Relinquished By (2),
<br />,-,, Received'ay12)
<br />Signat, re—
<br />Daterr
<br />,
<br />nature
<br />Date/Time
<br />Signature
<br />Date/Time
<br />Signature /,,
<br />Daterrime
<br />61 Olit .
<br />A tleaCrertGrou
<br />P„,,, A7Vi.41111(91 Si111.1, { 4 [111.11,011
<br />CHAIN OF STC
<br />1341 Cannon Street - Louisville, CO 80027
<br />(303) 661.9324 - FAX (303) 661.9325
<br />
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