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CHAIN OF CUSTODY <br />Ciientjtlroject Name: 4". —f tJ ` —,x-�. <br />D.©. / ?roject Number, K�CAA1 <br />Lontact' ty <br />c <br />t, <br />Address: 2 L4 c. W % 'P— J, 2!4A Lz ri 8l zg <br />0 —° <br />m <br />a <br />T <br />y <br />z <br />Phone tr at To 646 757ciD <br />L-10,10. CIF t,(JC -trl luJc iilr,o <br />L <br />' <br />ri <br />0 <br />c <br />J <br />w <br />% <br />rs <br />Fax # 77 0 &(A Z ! rr5' <br />Sampler: I f= <br />Report By: ®Iti9il{ �fst)i i•Aii <br />Sample Lucatipn or ID <br />Date <br />Time <br />Grab/ <br />comp <br />Lab Ed <br />i <br />Turnaround Requirements <br />'Ar iMi al Testirw Only) <br />Standard (10 bays) <br />3 -S Jay <br />Requested Repurt Dare: <br />Relinquished By (1) <br />Slgnatur. _ _ Cate/ tme Si <br />1341 Cannon Street - Louisville, CO 8OU21 <br />(303) 661.9324 � rAX (303) 661.935 <br />Analysis (Check all ,applicable) <br />c:a <br />=' + U <br />v <br />71 �, <br />C-5 ✓f �G _ <br />© — qd G _T <br />C i <br />7 "� t <br />< v C ct m O <br />G <br />a ` <br />cy E <br />Q 3 <br />� 4 <br />� r <br />z� <br />t 9° <br />Test Species: ❑Fathead Minnow �eriQdaphnVa ®Daphnia magna � Daphnia puiex Q Other (list Below► <br />6 -9 Day Special Instructions /Comments: <br />1 -2 Day � <br />Received By (1) Relinquished By (2) Received By (2) <br />gnature Udtcrl-'ne Signature Datr"Time Sy at t nAt./T,rnp <br />