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Client /Project Name: I, zsl jLW T - VAILLS (cu..A\P -A j <br />applicable) <br />P.O. /Project Number: 0¢v..) 22_01) (AZtj 4 <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 />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 />awnion ietol <br />Contact: — (, l - ( <br />Address: 27 (,4 <br />G w 5/1 A �� f 0Gt-A- Co 2144 14 <br />Phone # (t 70 gc,4 Ts'10 <br />E -Mail: t FicYcli, Vt)1`GtJOC A , O. -„ <br />Fax# 0 ( 70 VGA- 2-1 vg <br />Sampler: <br />❑ FAX <br />Re By: ❑ Mail <br />Report v <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />ILABU onivf <br />Vi ?bil s 01 .S. <br />‘ 1(3 ‘ \-2-- <br />l l 0 <br />C <br />�.x ;� a , ,� <br />l <br />G <br />Turnaround Requirements <br />(Anal vticat'sestina Only) <br />Test Species: ❑ Fathead Minnow EaCaodaphnia ❑ Daphnia magna ❑ Daphnia pulex <br />Other (List Below) <br />'a` <br />Standard (10 <br />days) <br />6-9 Day <br />1 -2 Day <br />Special Instructions /Comments: <br />3 -5 Day <br />Reqpested Report Date: <br />Relinquished By (1); <br />Received By (1) <br />Relinquished By (2) <br />Received By (2); <br />Sign re <br />Date /Time, tri. <br />.� (gyp <br />1 <br />Signature <br />Date /Time <br />Signature <br />Date /Time <br />Signature , <br />�� `, <br />Date /Time <br />;(' <br />eaCrettGrou <br />., AN. ;M.r,,...C.■to, . ,.0M. "VV P <br />CHAIN OF CUSTODY <br />1341 Cannon Street Louisville, CO 80027 <br />(303) 661.93: 303) 661.9325 <br />