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No. 19 b Z ib <br /> CORE LABORATORIES, INC. <br /> CHAIN OF CUSTODY RECORD <br /> I <br /> CUSTOMER INFORMATION PROJECT INFORMATION 0 <br /> COMPAII •�-•l�! ' PR T AM N / / ! �hZ N <br /> r W <br /> SEND REPORT TO BILLING INFORMATION z ♦ tV <br /> I <br /> A E 1 r BILL TO -7 6 �R &3 ,,' p ��vJ <br /> C CA ADDRESS o ��QV LAB JOB NO. <br /> Cc <br /> F--= <br /> PHOco <br /> NE PHONE 4 <br /> FAX _ �� FAX PO NO Z <br /> I r <br /> SAMFLE NO SAMPLE DESCRIPTION SAMPLE SAMPLE SAMPLE CONTAINER i'RESERV REMARKS I PRECAUTIONS <br /> SSS <br /> DATE <br /> TIME MATRIX <br /> i \/ lOr O t1 <br /> 10-1 <br /> -fz 3',�c� G LA0 1k x <br /> w <br /> a <br /> ¢ SAMPLER SHIPMENT METHOD AIRBILL NO <br /> t _ <br /> ac REQUIRED TU NARO D* F1 SAME DAY 24 HOURS 48 HOURS -1 72 HOURS 5 DAYS 17' 10 DAYS ❑ ROUTINE OTHER CA <br /> 1 R£LINOUV H $Y DATE 2 RFLINQUIW44Y DATE 3 RELINQUISHED BY DATE <br /> SIGNATU SIGNATU SIGNATURE <br /> PRINTED NAME/COMPANY TIME PRkNTED N EJCOMPANY TIME PRINTED NAMEICOMPANY TIME <br /> of <br /> Q i <br /> z (1 RECEIVED BY DATE 2 RECEIVE BY DATE 3 RECEIVED BY DATE <br /> cr <br /> SIGNATURE— SIG SIGNATURE <br /> UI <br /> Q PRINTED NAMEICOMPANY_ TIME _}�"� PRINTED ME1C MPA My E PRINTED NAMEICOMPANY TIME <br /> Z�rL � dLJ <br /> ❑ Anehaim CA 11 Aurora CO ❑ Caspar WY ❑ Corpus Christi 17( <br /> 1250E Gene Autry Way 10703 E Bethany Dme 420 W First Street 1733N Padre Island Drrve <br /> Anahe+-CA 92005 Aurora CO 80(114 Casper WY 62601 Corpus Christ TX 78400 <br /> (714)937 1094 Fax(714)937 1170 (303)751 1780 Fa.(303)751 1784 (307)235 5741 Fax(307)286 1676 (361)289 2673 Fax 1361)2B9 2471 <br /> ❑ TX(Env) ❑ Houston Mosley <br /> Rod <br /> ❑ Lake Charles Parkway <br /> ❑ Valparaiso IN <br /> hway Dnve 6270 Mosley Road 3645 9eghs Parkway 2400 sum r4iand Onv <br /> -77040 Houston TX 77075 Sulphur LA 79667 Valpara+a0 IN 4639,1 <br /> {71 690 4444 Fax 17131 690 5646 (773!943 9776 Fax(713)943 3846 {316)563 4926 Fax 1318)083 4929 [2191 464 2369 Fax(202953 <br />