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Ar4aCre,ptO.roup <br />CHAIN OF CUSTODY <br />1341 Cannon Street - Louisville, CO 80017 <br />(303) 661.9324 - FAX (303) 661.9325 <br />l <br />Client /Project Name: a'vC- i-S (c %-C3 � G, <br />Analysis (Check all applicable) <br />P.O. /Project Number: y� E tai �i�(Liz�fN ��1Cz <br />N <br />CID <br />a; <br />a <br />u <br />a <br />r <br />S <br />o <br />W <br />o <br />C <br />t <br />v <br />w <br />3 <br />0 <br />d <br />� <br />c <br />o <br />Y <br />`, <br />U <br />v <br />w <br />> <br />> <br />3 <br />0 <br />m <br />v <br />C <br />w <br />Uj <br />\ <br />a <br />w <br />> <br />3 <br />3 <br />0 <br />m <br />J <br />v <br />C <br />G <br />u <br />!— <br />o <br />� <br />-o <br />o <br />N <br />3 <br />O <br />`° <br />�' <br />0 <br />c <br />Q <br />V <br />O <br />0 <br />1E <br />U <br />v <br />o <br />v <br />� <br />v <br />o <br />~ <br />C`o <br />_ <br />o <br />U <br />u <br />U <br />o <br />m <br />o <br />v <br />m <br />_> <br />M <br />Q <br />r <br />o <br />a <br />a+ <br />v <br />O <br />E <br />Z <br />E <br />O <br />> <br />ca <br />o <br />�-• <br />_ <br />Contact: j tZ <br />Address: 17 /� JFi i -`� <br />Phone # `2 7a 7J ctC? <br />E -Mail: j =z 4Z C� W1--CNh-xbk, C <br />Fax # �/ )C f� �f 2 j & <br />Sampler: � � <br />Report By: ❑ Mail FAX <br />Sample Location or ID <br />Date <br />Time <br />Grab/ <br />Comp <br />Lab ID <br />(1AB J. Onty) <br />Turnaround Requirements <br />Testing (Analytical Only) <br />Test Species: Dfathead Minnow 1216riodaphnia ❑ 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 />1 'D <br />Da; /Tim <br />$12D�� <br />l l 3 U <br />Signature <br />5 ,��� �� I, <br />- } <br />Date/Time <br />o s �r i? <br />i �5 <br />Signaturr <br />Date /Time <br />Signature <br />Date /Time <br />