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No. 19 5 2 r b <br /> CORE LABORATORIES, INC. <br /> CHAIN OF CUSTODY RECORD <br /> CUSTOMER INFORMATION PROJECT INFORMATION <br /> GDMPAN PhAEIN 8 7 J � <br /> SEND REPORT TO BILLING INFORMATION a Jy <br /> ADSS �� BiLLTD Z , �Q <br /> U ADDRESS V Qv' Q LAB JOB NO. <br /> 0.1 =TC. cam- O Q 1Q <br /> W <br /> PHO F�.n f\ �1�_g C` PHONE � <br /> FAX � i FAX PO NO Z <br /> l�7 <br /> S LE NO SAMPLE DESCRIPTION SAMAM <br /> SAMPLE SAMPLE SAMPLE CONTAINER PRESERV REMARKS I PRECAUTIONS <br /> DATE TIME MATRIX <br /> 3 <br /> a-r) vo `. boy 14rL 3 N <br /> r <br /> Par <br /> Vn <br /> C <br /> �I <br /> I <br /> 0 <br /> Q <br /> a <br /> a <br /> c SAMPLER SHIPMENT METHOD AIRBILL NO <br /> 0 <br /> REQUIRED TURNAROUND* ❑ SAME DAY ❑ 24 HOURS ❑48 HOURS ❑72 HOURS ❑5 DAYS ❑ 10 DAYS ❑ ROUTINE OTHER <br /> 1 RELINQUISHED BY DATE 2 RELINQUISHED BY DATE 3 RELINQUISHED BY DATE <br /> SIGNATURE SIGNATURE SIGNATURE <br /> PRINTED NAMEICOMPANY TIME PRINTED NAM COMPANY TIME PRINTED NAMFiCOMPANY TIME <br /> 0 <br /> cr <br /> Z 1 RECEIVED BYE 2 RECEIVED Y DATE 3 RECEIVED BY DATE <br /> am <br /> SIGNATUAE AIT X7 SIGNAT h/f SIGNATURE <br /> x III(( <br /> w PRINTED NAMEICOMPANY TIME PRINTED N ElCO PANY TIME PRINTED NAMEICOMPANY TIME <br /> Cc E7 Anaheim CA ❑ Awwa CO ❑ Caspar Yvy 0 Corpus Christi TX <br /> 1250 E Gane Autry Way 10703 E Bethany Dme 420 W First Street 1733 N Padre]bland Drive <br /> Anaheim CA 92805 Aurora CO 80014 Casper WY 82601 Corpus Chush TX 78109 <br /> 937 4094 Fax(714)937 1170 (303)751 1780 Fax(303)751 4784 (307)235 5741 Fax(307)266 1676 4361)289 2673 Fax 2471 <br /> on TX(Env) ❑ Houston TX(P.11 . ❑ Lehe Charles LA (3Velpuel.o IN <br /> 0 Ro0lway Dme a210 Mosley Road 3645 Bees Parkway 2400 Cumberland <br /> Houston " <br /> 77040 Houston TX 77075 Sulphur LA 70663 Valparaiso IN 46763 <br /> 17131690 4444 Fax 17131 690-5646 17131943 9776 Fax(7131 943 3946 131M 5A3 4926 Fax 19181 5A3-4929 014%4f 9 4 F.x 491 G1 497 J�-Z <br />