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Client /Project Name: j FR,KA �-Ufi_S CDI_o, X <br />applicable) <br />P.O. /Project Number: 10e_vt) [AvA - 2_ 0N M'Z'F <br />WET: Acute (Indicate Below) <br />WET: Chronic (Indicate Below) <br />(rnopg aleaipui) paleJalany :13M <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 />Total Volume �l <br />Contact: t o <br />Address: 2.7 1.40. W x <br />`'` <br />)J ut ' to c i42-4 <br />A vil. <br />Phone # % 7 D V• 4 7C. 90 <br />E -Mail: / r`a7 (A) FC.NUC,64, 047 <br />Fax # 6' 70 5(9 4- 2-2- L. <br />Sampler: p=ity <br />Report By: ❑ Mail � - r13r ❑ FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab / <br />Comp <br />Lab ID <br />ILAB Use Only) <br />W M ' S t.(a„ <br />Cl . 1 Z i L <br />j O O <br />.� <br />(a <br />roj <br />Turnaround Requirements <br />(Analytical Testing only) <br />Test Species: Fathead Minnow Q"Ceriodaphnia ❑Daphnia magna Daphnia pulex <br />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 />Signature <br />s .,-- <br />Date/Time Z <br />1 00 <br />Signature <br />Date/Time <br />Signature <br />Date /Time <br />Signature q <br />,. u::r✓ 1 <br />Date /Time <br />w t <br />I <br />CHAIN OF <br />STOCUDY <br />Cannon Street Louisville, CO 80027 <br />(303) 661.93 403) 661.9325 <br />