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~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ r• ~ ~ ~ ~ ~ <br />CHAIN OF CUSTODY RECORD /ANALYTICAL SERVICES REQUEST <br /> <br />COMPAN ~j'`~ <br /></L <br />'1 <br />1 Evergreen Analytical Inc. <br />Y / <br />/ C/ <br />c-or. n 4036 Youngfield St. <br />ADDRESS ~ o ~'z S la . s--JO I' <br />FRA,.h4 {~ /V /^~ Wheat Ridge, Colorado 80033 <br />CITY I~ ~ /(. <br />STATE `~ Z / \ <br />IP SOO ~J ~ /\ (303) 425-6021 <br />FAX (303) 425-6854 <br />PHONEt/ 3 v 3 - yz - 33 cc7 <br />FAXq '3~3-4Z3-3353 (800) 845-7400 <br />REPORTT~( rM Ms)_ Crw ~~ rrJzN- <br />irJVnicc rn (' r ~. ~ De....-i-h <br />Report Results <br />Standard 2 working weeks ^ <br />3 day UST Analyses per Fee Schedule <br />'Rush: ^ < 24 hrs ^ 1 - 2 work days <br />^ 3 - 5 work days ^ 6 - 9 work days <br />'Rush analysis subject to additional fee <br />Pageof <br />PRO~ECn.D. 4 (0 02 ~ oS9 M ATR IX ANALYSIS REQUESTED ~Eor Laboratory <br />' <br />Po <br />u E <br />~~e~ ~~ <br />•r <br />~ <br />u <br />e only <br />. <br />a~.ouoreu ~ , <br />~ <br />s <br /> <br />Sampler Name: <br />~ N ~ (O <br /> <br />3 <br />~° ~, ~ m° ~ wo #~ S 9 <br />+ <br />(Print) L'2a f G Prd~'~' ~ " <br />~ ~` ~' ~ m° ~'B O F # ~l'."t . <br />.o °' v ~ <br />~ 3 ~ <br />m m <br />si nature) //''~~ ~ . <br />v <br />m E ~' c -` ~ m "C/S O h ~ rN "` <br /> C!S (I)' ! <br /> <br />P R i N T <br />m (7 <br />` _¢ <br />~ a a o ~ E ~ ~ (7 O za Oa <br />~ <br />a ~ ~ ° ° `O ° ` \ m =' ~ ~ Cooler Temp C <br />3 <br />Please ~ ~ <br />a ~ z .,. ~ w m ° h a o 0 <br />d ~° a c ~- • <br />' <br />~ <br /> c° ~ d N~ <br />a ~ m w° w° c m m° E E~ E ^~ E m Seals Intact Y / <br />~ <br />all information: o <br />U =- <br />~ ° <br />° a <br />> o ° ° y °' ~ = ~.y <br />~ ~ _w ` <br />:' Samples Pres.Y NA .:, <br />> N N a v v ~ ~ <br />° °im d <br />° <br />SAMPLE DATE ~ ~ ° m m ,~ <br />w <br />w <br />a Q Q .o ~ `0 a - x r ~ m 'o m c7 /~ ''HeadspaceY/~ NA <br /> <br />IDENTIFICATION SAMPLED TIME <br />z° <br />`" o ~ <br />p ~ o z ~ v v m~~ w o.~ ~.: °' 1 <br />,° <br />,! <br />~ m a a a x r <br />~ ~ ~ o <br />p By~* <br />' <br /> 4 <br />x <br />- <br />` <br />. <br />~ <br />S~- I 4_ ~zr, 8-z~-cL t%; yo ~ i ~.°r: <br />" ~(JI - <br />~~ <br /> . <br /> <br /> <br /> <br /> <br /> <br /> <br />SP-~ 2y-3o" jz ,S r )( X ds <br />SP-6 b"u~ It:LO i X a . <br /> <br /> <br /> -, <br /> <br />' ' ~ ' '-Sample Fractiori . Loc. '- ~ ' <br />Instructions. Co <br />ntalner ;; <br />_ , <br />~ <br /> <br /> <br />!~'~ g/ 3fi`~2L <br />v'3~~-- <br />t= w I ( () CFI ZL <br />ua[ei i ime I rceungwshec <br />s-3~-~z ~ <br />4 ~ ~OP`^- <br />uate/lime <br />f - 3-e ~2 <br />~f : 4°o p- <br /> <br />y~4F/ <br />