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CHAIN OF CUSTODY <br />Chent/Project Name: <br />P.O./Project Number: <br />0 <br />M <br />CU <br />f <br />Addrc,5: 114 Moak. co 9 <br />A <br />Phone 4 fiV WA. <br />OWT 7 40 <br />E-Mail: <br />Fax P 76 5C4 <br />Sampler: t <br />Report 8y: Mail 4D15 5F FAX <br />CL <br />Sample Location or ID <br />Date <br />Time i <br />0 0 <br />Lab ID <br />t, <br />z <br />10 zo <br />1341 Cannon Street - Louisville, Co 80027 <br />(303) 661.9324 PAX (303) 661.9325 <br />Analysis (Check all applicable) <br />Turnaround Requirements Test Species [—]—fathead minnow [Tcenodaphnia MDaphnla magna o Mphnia pulex ❑ Other (List Below) <br />Standard I 10 daysi 6-9 Day Special Instructions /comments., <br />3 -5 D.,y 1 2 Day <br />Requested Report Date-. <br />Relinquished By (2) Received By (1) Relinquished By (2) Received By (2) <br />ujtw/ I III I �klgrijhjre ndtLMME E SiFnatury Z. DativTime <br />0 <br />7 <br />M <br />> <br />0 <br />E <br />vvi <br />U) <br />> <br />P <br />-= <br />Cj <br />0 <br />Turnaround Requirements Test Species [—]—fathead minnow [Tcenodaphnia MDaphnla magna o Mphnia pulex ❑ Other (List Below) <br />Standard I 10 daysi 6-9 Day Special Instructions /comments., <br />3 -5 D.,y 1 2 Day <br />Requested Report Date-. <br />Relinquished By (2) Received By (1) Relinquished By (2) Received By (2) <br />ujtw/ I III I �klgrijhjre ndtLMME E SiFnatury Z. DativTime <br />