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C. kIC n t /I' ro 3E2 ci. Narne: IP_ ::"'''' '',':'. -*, • , - 4,,„. <br />Analysis (Check all applicable) <br />P.O./Project Number: <br />"CIL:I=Tr. <br />; <br />(molar! oinpui}:nr <br />(enolog ale.tqAt II ;1.1034) <br />1111111111111111111111111111111111 <br />III <br />1 .11111111111111 <br />I= <br />11aaimuuua <br />Metals (list Below <br />III <br />1 kwitls (TS/MS/ de; <br />11111 <br />11111 <br />III <br />11111111111 <br />IIIIIIIIIIIIII <br />aseaJD pue 1110 <br />Ii D) W1/111 w <br />(op suo!kiv <br />111111 <br />III <br />I 1 1 <br />111111111 <br />I I 1 <br />BOD/COID (Crrcle) <br />IIIIIIRE <br />III <br />1 1 th 1 1 1 lOer Attalysic ( la <br />._Nt Bew) <br />1111111111111n <br />' <br />Ill <br />III <br />BEI <br />1 •r", Number uf Containers <br />Total Volume <br />row ar t. ' <br />Address 1,7 <br />— 4) L.A CO g t 474 <br />Phone ; 4 7 °to <br />E-maik, <br />Fax # `1 TO 344 Z14 <br />Sampler: <br />Report 6y: El Mail ....Er L 0 FAX ..17.7.'"°2■ <br />Sample Location or ID <br />Date <br />Time <br />G 4 . <br />Co* <br />Lab ID <br />s 03 <br />7. , 1 <br />020 <br />, , <br />i.ctivk , .kAptc. <br />IIIIMIIIIIEMIIIIIIII <br />111111111111 <br />NI= <br />II <br />MN <br />ill <br />EN <br />Turnaround Requirements <br />:Analyt tot TeStirie OnEv) <br />Test Species: athead Minnow Ereriodaphnia DDaphnia magna Daphnia puIe 0 Other {List t3elow) <br />Standard 110 <br />daysi <br />_ <br />6-9 Day <br />1 2 Ddy <br />Special Instructions/Commems: <br />3 - 5 D <br />Requested Report Date: <br />Relinquished By (1) <br />Received By (1) <br />Relinqui By (2) <br />Received By (2) <br />s <br />uatz ia t 2. <br />..,.,--'-'"-----' <br />,*Krtature <br />r, telrime <br />Signaturo <br />Dz <br />1 naturr <br />. <br />.--1 <br />' <br />IV <br />/ <br />i° . 4 <br />Date/Time <br />... <br />, , <br />— <br />,- <br />, .,, <br />Licacrs.t.OF.9!OP <br />CHAIN OF CUSTODY <br />1341 Cannon Street - Louisville, CO 80027 <br />(303) 661.9324 FAX (303) 661.D325 <br />