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Client, / Projec <br />applicable) <br />P.O. /Project Number: <br />WET: Acute (Indicate Below) <br />WET: Chronic (Indicate Below) <br />L <br />WET: Accelerated (Indicate Below) <br />WET: PTI /TIE /TRE (Indicate Below) <br />Metals (List Bew) t r <br />Solids (TS /TD <br />sfr <br />SS) (Circle) <br />(nne ) suoluy <br />Chroaf it (Cfrcie) <br />' a`r' pue 110 <br />Coliform (Tot F nl /E -Coli) (Circi <br />BOD /COD (Circlet <br />Other Analysis (E# Below) <br />L si u!eWioD 3 ; = • n <br />Tot Vo ime = <br />Contact:,,, <br />Address: �:' •` a 4 <br />Phone # <br />E- Mail: `ti <br />Fax # <br />Sampler: •� <br />Report By: Mail • DF [] FAX <br />Sample Loca or ID <br />Date <br />Time <br />Grab / <br />Com• <br />Lab ID <br />(LAB Use Only) <br />LJ ?N 6. t 3 <br />I 4 <br />001,t. <br />-Mel <br />1 <br />lig <br />II <br />MIS <br />111111 <br />1111 <br />II <br />Turnaround Requirements <br />' (Analytical Testing Only) <br />Test Species: athead Minnow eriodaphnia <br />Daphnia magna ❑ Daphnia pulex <br />Other (List Below) <br />R <br />S <br />Standard (10 <br />days) <br />6 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 />Date /Time `LZj i ^^ . <br />«may LL. <br />Signature <br />Date/Time <br />t' � <br />Signature <br />Date /Time <br />Signature <br />Date /Time <br />ScoCrcitGrou <br />ax $ NY 531yX 4.44 w7 al .T.. lC. .luR.nrwr P <br />CHAIN OF CUSTODY <br />1341 Cannon Street Louisville, C,) 80027 <br />(303) 661.93 303) 661.9325 <br />