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Client /Project Name: V3 S =-SST 2i3 Rvt� L` Co I-0 2A 0 <br />applicable) <br />P.O. /Project Number: Ock.ki <br />Hor cZ.00 \c a_ <br />WET: Acute (Indicate Below) <br />(mope ateolpui) DIuoND :13M <br />\WET: Accelerated (Indicate Below) <br />WET: PTI /TIE /TRE (Indicate Below) 1 <br />Metals (List Below) <br />Solids (TS /TDS /TSS) (Circle) <br />Anions (List Below) <br />Chromium III /VI (Circle) <br />Oil and Grease <br />Coliform (Total /Fecal /E -Coll) (Circle) <br />BOD /COD (Circle) <br />OtherAnalysk (List Below) <br />Number of Containers <br />1 awnioA (eto,E <br />1 <br />Contact: t p,,,,,._ <br />Address: 2] 6 4 c- S ni ,4i& /li vciJ- 2 <br />Phone # Ct7e, g, 4f 7O <br />E -Mail: r cuook - ,o <br />Fax # Gj 7v <br />Sampler: ( F( i' <br />e <br />F [] FAX <br />Report By: R Mail <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(tabu$e <br />p?‘ ,2 <br />(0,s <br />Ma I a <br />t C <br />.t—,-) <br />' <br />Z <br />- 711-1C- <br />1 <br />8 <br />Test <br />Species: <br />athead Minnow <br />EKriodaphnia <br />Daphnia <br />magna <br />Daphnia <br />pulex <br />Other <br />(List <br />Below) <br />TurnarouCt Requirements, <br />(Analytical Testing Onlvt <br />i♦ <br />Standard (10 <br />days) <br />6-9 Day <br />1 -2 Day <br />Special Instructions /Comments: <br />3 -5 Day <br />R. quested Report Date: <br />� <br />°� ..;.;.'' �Re[inquished By (11 <br />.. Received By (1) <br />Relinquished B. � <br />• <br />.. . 'R ec a eii`• <br />u } <br />$I ndt <br />Signature <br />Date/Tim� 11 <br />Si�nat r <br />Date/Time <br />7 <br />v � J <br />Signature <br />Date/Time <br />Signature <br />Date/Time <br />e*CrcitGrou <br />AM ■ MYrdb HMPN CAI 5(4rV,I, • OMn &M• P <br />CHAIN Of CUSTODY <br />341 Cannon Street svile CO 80027 <br />(303) 661.1 FAX (303) 661.9325 <br />