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Client /Project Name: G CT -NCI rVc_L. C3 <br />applicable) <br />P.O. /Project Number: !" ,eu) 14 1M c 1-3(^,, - <br />v/ET: Acute (Indiciitc'. eclow) <br />WET: Chronic (Indicate Below) <br />I 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 />aseaJ9 pue 11O <br />Coliform (Total /Fecal /E -Coll) (Circle) <br />BOD/COD (Circle) <br />Other Analysis (List Below) <br />Number of Containers <br />Total Volume <br />Contact: `, 4 vv., FR <br />Address: 21 U 4e, I O U S rilk 4w. p{,e..t,A-, cf cl <br />Phone # 0( 7 16 4 100 <br />E -Mail: T e l fir- e- .ar-4 494.6 <br />Fax # /7 G $ 6.4- 2-1 G v <br />Sampler: <br />P[�F Q FAX <br />Report By: Mail <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Coma_ <br />Lab ID <br />(L48 use Only) <br />7 Lim <br />t <br />J <br />1 <br />Turnaround Requirementx <br />(Analytical Testing Only/ <br />Test Species: ❑Fathead Minnow rfodaphnia � Daphnia magna Q Daphnia pulex ❑Other (List Betaw) <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 />to /Ti <br />` <br />1 o3a <br />Sign ure > <br />L.,,/ <br />t' <br />Date/Time <br />Signature <br />Date /Time <br />Signature <br />Date(ilme <br />fieoCre,tGrou <br />P <br />N l Nb1i11N #e N IA1 ., NYl e, Lo MPANY P <br />CHAIN OF CUSTODY <br />1341 Cannon Street Louisville, CO 80027 <br />(303) 66193 24 - FAX (303) 66L9325 <br />. —, <br />