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A& <br />.,LSe. 1Cre.PtGroup <br />CHAIN OF CUSTODY <br />1341 Cannon Street - Louisville, CO 80027 <br />(303) 661.9324 - FAX (303) �6Z.9325 <br />Client /Project Name: <br />Analysis (Check all applicable) <br />P.O. /Project Number: j,J I -j0 _V?k >ti 7— <br />a) <br />m <br />a) <br />+� <br />Q <br />a <br />w <br />S <br />o <br />m <br />ro <br />_ <br />" <br />C <br />O <br />t <br />u <br />W <br />3 <br />o <br />m <br />' <br />iG <br />c <br />a; <br />a) <br />U <br />Q <br />w <br />3 <br />o <br />m <br />° <br />c <br />w <br />0- <br />w <br />3 <br />o <br />° <br />'_^ <br />= <br />cv <br />L <br />v <br />-_ <br />o <br />o <br />., <br />3 <br />o <br />° <br />.. <br />T <br />z= <br />.o <br />Q <br />° <br />" <br />O <br />L <br />U <br />� <br />y <br />M <br />— <br />o <br />v <br />� <br />LL <br />o <br />E <br />° <br />o <br />L..7 <br />a, <br />u <br />— <br />o <br />o <br />o <br />r1] <br />v <br />m <br />- <br />ra <br />o <br />c <br />r <br />O <br />a <br />c <br />U <br />— <br />o <br />c <br />-0> <br />£ <br />z <br />01 <br />E <br />7 <br />o <br />o <br />�-• <br />�-- <br />Contact: �.LAJ,S <br />Address: 2-7 VU S'� l�v+�— {�f ,t.:'f S 1 L <br />Phone # 9 2) S(. <br />E -Mail: ' -'={Z �' w'i�NUCVk<C <br />Fax # 7o X44 21 63 <br />Sampler: (�—'iZ <br />Report B: ❑ Mail ❑ FAX <br />P Y <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(1AB U. Only) <br />Turnaround Requirements <br />(Analytical T <br />Test Species: Ejfathead Minnow ❑ Ceriodaphnia ❑ Daphnia magna ❑ Daphnia pulex ❑ Other (List Below) <br />Standard (10 days) 6 -9 Day <br />3 -5 Day 1 -2 Day <br />Requested Report Date: <br />Special Instructions /Comments: <br />Relinquished By (1) <br />Received By (1) <br />Relinquished By (2) <br />Received By (2) <br />Signature <br />,� <br />Date/Time <br />c. to <br />Signature <br />Date/Time <br />Sigmature <br />Date/Time <br />Signature <br />Date /Time <br />