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CORE LABORATORIES, INC. N0. 12 5 d 5 y <br /> 4 CHAIN OF CUSTODY RECORD <br /> CUSTOMER INFORMATION PROJECT INFORMATION �O <br /> COMPAN V PROJECT NAMEINUMBEA <br /> ticaRrro BILLING INFORMATION z �y <br /> A500 <br /> ADDRES �+ BILL TO Fa. mac) <br /> ADDRESS � �=Q�Q LAB JOB NO. <br /> LL <br /> 0 <br /> L!1 <br /> PHDN *�O PHONE cm <br /> `f`{-� cm <br /> FAX - f FAX PO NO16- <br /> SAMPLE NO SAMPLE DESCRIPTION SsIME MATRIX T <br /> CONTAINER PRESERV REMARKS/ PRECAU,TIONS <br /> � DATE TIME �X/ <br /> a <br /> x <br /> s SAMPLER SHIPMENT METHOD AIRBILL NO <br /> j REOUI TURNARqJND ❑ SAME DAY ❑ 24 HOURS `48 HOURS ❑ 72 HOURS ❑5 DAYS ❑ 10 DAYS ❑ ROUTINE OTHER <br /> xW I <br /> 1 REU SHED 13Y I DTE 2 RELINOUISHED BY DATE 3 RELINQUISHED BY DATE <br /> cc <br /> SI TU SIGNATURE SIGNATURE <br /> PRIWTE N COM TIME PRINTED NAME/COMPANY TIME PRINTED NAME/COMPANY TIME <br /> 0 <br /> z 1 RECEIVED BY DATE 2 RECEIVED BY DATE 3 RECEIVED BY DATE <br /> SIGNATURE SIGNATURE SIGNATURE <br /> x <br /> PRINTED N OM ANY T PRINTED NAMEICOMPANY TIME PRINTED NAMElCOMPANY TIME <br /> Q Anaheim CA ❑ Aurers 00 ❑ Carson CA ❑ Casper WY ❑ Corpus ChrisB TX ❑ Edlfon N,1 <br /> 1250 E Bona Autry Way 10703 E Bethany Dnve 2!730 S Wilmington Ave Suite 201 420 W Fust Street 1737 N Padre Island Dmrf 294 Raritan Confer Parkway <br /> Anahm CA 82805 Aurora CO 80014 Carson G 9081 -1640 Caspar WY 82801 Carpus Chnsh TX 7&409 Edison NJ 08837 <br /> (714)937 1084 Fax(714)937 1170 (303)751 1780 Fax(303)751 1764 (310)513 2031 Fax(310)513 2035 (307)235-5741 Fax(307)26&1878 (512)289 2673 Fax(512)289-2471 (732)225 780 Fax(7321715-8777 <br /> ❑ Ha1lalarl.TX(Env) ❑ Houston TX NQ ❑ Indlar»poef W Q Lake Cholas,U 13224�00�Cu 6e end Dive <br /> 6310 RoBtway Dl" 8210 MoiNy Road 7726 Moser Road 3645 Beglu Parkway <br /> Houxwn TX 770400 Houston TX 7707S Indianapolis W 48268 SWphur LA 70553 Valpuetso IN 48383 <br /> (713)VX"444 Fax(713)8845846 (713)9434778 Fax(7131 843-3848 {317)8753894 Fax(3M 872-6188 (318)583.4926 Fax(318)503-487A (2191484.2389 Fax{219)462,2853 <br />