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Client /Project Name: _ — � Z " "1...)13-LL .0t—L5 { <br />applicable) <br />P.O. /Project Number: <br />-� <br />N <br />, mot <br />WET: Acute (Indcte Below) <br />WET: Chronic (Indicate Below) <br />'°' eolpul) paleaalaDJV :13M <br />I WET: PTI /TIE /TRE (Indicate Below) <br />■ <br />. <br />Metals (List Below) <br />Solids (TS /TDS /TSS) (Circle) <br />Anions (List Below) <br />■■■■ <br />Chromium 111 /VI (Circle) <br />1 <br />Oil and Grease <br />Coliform (Total /Fecal /E -Coli) (Circle) <br />BOD /COD (Circle) <br />Other Analysis (List Below) <br />■■■■ <br />Number of Containers <br />'Total Volume <br />Contact: t ca I .,. <br />Address: - 2. (,. !..1,± G _z <br />Phone # ° ( 7O g 44 Z s 9 O <br />E -Mail: [ , iky ( Z uc • <br />Fax # 1 70 V 4 2_4 1.q <br />Sampler: <br />• � <br />,C (''' <br />Report By: ❑ Mail ' r [J FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Com <br />Lab ID <br />(LAB Use Only) <br />p V t '"" • ,, <br />1 0 • j 2 <br />, <br />BM <br />E■ <br />2, <br />NI <br />' �. <br />e.,,, ( k<", <br />WI <br />■■■ <br />1 <br />11111 <br />III <br />■■■ <br />■■■■ <br />■■■■ <br />■ <br />■■■■■ <br />■■■■■ <br />■■■ <br />■ <br />■ <br />■■■■■ <br />II <br />■■■■■ <br />■■■■ <br />■■■■■ <br />1111 <br />Requirements <br />.IT <br />III <br />Nimmim <br />-, Turnaround! <br />1 i <br />1 c • <br />IMO <br />IIIIII <br />Test Species: C athead Minnow Ceriodaphnia Daphnia magna ❑ Daphnia pulex 0 Other (List Below) <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 />el iraquiS ed By (1) <br />enied Ay(1) <br />Relinquish, . Y <br />Re c lved <br />Signature <br />Date/Time <br />, Z <br />Signatur '' <br />Date/Time <br />Signature <br />Date /Time <br />Signature <br />Date/Time <br />rioCrortGr <br />CHAIN OF CUSTODY <br />341 Cannon Street s■ille, CO 8002; <br />(303) 661.E FAX (303) 661.932! <br />