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Date Due/-//•y'/ <br />Holdinq TimePP/!•9s,~P <br />EVERGREEN ANALYTICAL, INC. C'ry` /.t~.t~?f~~o <br />4036 Youngfield, Wheat Ridge, CO 80033 aTyF.PSc i•,~ y•4/ <br />(303)425-6021 <br />•ient i <br />Address <br />Contact <br />Sampled <br />Client Project # <br />Client P.O. Od D <br />Phone # .733 -~ <br />Shipping Charges <br />Special Instruct <br />ie2. Sample Tags present? ~-~ <br />Sample Tags # listed?~~2~ <br />Sample(s) sealed7if~*'~~'!/O/. <br />Fax RPSII~YR~/Y._S. FAY Nnmhar 17_7 - ~9D.1. <br /> <br />1 <br />i <br /> <br />Lab <br />ID # Client <br />ID # <br />Analysis <br />Mtx <br />Btl <br />Loc <br />File #/Date <br />R* <br /> <br />n d <br />D U1- re .~r y,P a ~ a , <br />r T E f <br />CtJ ye,,d. <br />c <br />Xo <br />~' 3 <br />X oo y <br />X3oo -1 <br />~ ~ <br /> <br />( 3 w• / <br />~ <br />~a <br />r.+~. <br />'do <br />,' 0O <br />6 <br />(ea -~. <br />C ea <br />~' 0O <br />' o e F <br />o ~. <br />~a0 <br />0 <br /> OFScu• 2 <br />'30 0 8' <br /> <br /> <br />SAMPLE LOG SHEET <br />Project # /D/d.2 <br />'d Airbill # ~/a-~~i t~~~-_-1-.-~~~~ <br />Custody Seal present?~/cai <br />~Gi intact?~~ <br />RCl:C1V CU /1' ~p'S'Q COC Present7~i <br />Samples to be returned <br />• <br />