Copperstone-LR 960124 Analysis Request and Chain of Custody Record Page of
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[] DALES EAS 2575 LONE STAR DR., DALLAS, TEXAS 75212 (214) 631-2700
T E C H N O L O G I E S I N ~ ~ MID.ND EAS 1703 WEST INDUSTRIAL, MIDLAND, TEXAS 79701 (915) 683-3349
Project no~~ ClienVProject P.O.,
:: ~' Field Date Sample Sample
;~:.~:~D,~'~:.' Sample No./ and ~ o ~ ~ntainer Ty~ (Liquid Preser- ANALYSIS REQUESTED ~BORATORY
~ :::~.~ :~ Identification Time ~ ~ (Size/Mall) Sludge, Etc.) vative REMARKS
:::...
Samplers:(PrinO Relinquishedby~ ~ / ~ / Date: //~ Received by: Date: COCSealNo.
(Signature) r~ ~ Time: ~,'~ (Signature) Time:
~/'~~ Re.linquish~d by: ~ ~~ Date: Received by: Date: REC'D. ON ICE
Affiliation (Signature~ Time: (~naturo~ Time: Yes No
~~~ (~ Relinquished by: Date: ::::::::::::::::::::::::: :~' :::':': ~. ~e:/,~~ ~t: "
(Signature) Time:
Data ResultsTo: _
Results by REMARKS: .
Rush Charges Authorized 1.
I Yes No ~ 2. ~ T/ ~ I~ 5~7 ~ ~ :: .
TECHNOLOGIES INC ~
2575 Lone Star Drive P.O. Box 224227 - Dallas, Texas 75222 * 214-631-2700
Client Lewis Russey Client No.
J.F. Clack, Inc. Report No. D6-01-132
Rt. 1, Boz 177A Report D~te 61/26/96 15:15
Caddo Mills, TX 75135
Project Proj. # 9506 Phone: 903-527-4445 Fax:
Date Sampled 01/24/96 Sampled By Lewis Russe¥
Sample Type Liquid Transported by Lewis Russe¥
P.O. # Date Received 01/24/96
Lab No. Sample Identification
D6-01-132-01 #1
D6-01-132-02 ~2
D6-01-132-03 ~3
D6-01-132-04 #4
D6-01-132-05 #5
Our letters and reports are for the exclusive use of the
client to whom they are addressed and shall not be reproduced
except in full without the approval of the testing laboratory.
The use of our name must receive our prior written approval.
MAXIM
William J Gase, Supervisor
Order # D6-01-132 Pa
01/26/96 15:15 TEST RESULTS BY SAMPLE
Client: J.F. Clack, Inc.
Sample: 0lA #1 Collected: 01/24/96 03:30 Category: W
Detection D~te
Test Name Method Result Units Limit Sga~t~ A~&lwst
Total Coliform SM 9222 0 Cot./100 01/24/96 JE
Sample: 02A #2 Collected: 01/24/96 03:30 Category: W
Detection Date
Test Name Method Result Units . ~imit Started Analyst
Total Coliform SM 9222 0 Col./100 01/24/96 JE
Sample: 03A #3 Collected: 01/24/96 03:30 Category: W
~etection Date
Test Name Method Result Units Limit Started Analyst
Total Coliform SM 9222 0 Col./100 01/24/96 JE
Sample: 04A #4 Collected: 01/24/96 03:30 Category: W
Detection Date
Test Name Method Result Units Limit Started Analyst
Total Coliform SM 9222 0 Col./100 01/24/96 JE
Sample: 05A #5 Collected: 01/24/96 03:30 Category: W
~etection pa~e
Test Name Me~hod Result Units Limit Started Analys:
Total Coliform SM '9222 0 Col./100 01/24/96 JE