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CHAIN OF CUSTODY RECORD /ANALYTICAL SERVICES AGREEiVIENT ** Page~ot 2 <br />CLlENTINFORMATION Evergreen Analytical Laboratory Inc. <br />~~` ~~ f2 <br />CLIENT 1 t~ 1 Q~0(~(~~~~.5 S Report Results by: (Date)` <br /> ^ 4036Youngfield <br />t. <br />ADDRESS ? d ~ L7~ ~ ~ ^ Wheat Ridge, Colorado 80033 Standard 2 worsting weeks <br />~~ _~"~~~~ <br />CITY ~,~_STATE W Z1P g~~ ~ (303) 425-6021 <br />FAX (303) 425-6854 UST Analyses per Fee Schedule ^ <br /> <br />PHONE~O 3 • g33 ~ `~~P FAX ~ 03 - g3 <br />3 - oZgSs~ E-mail <br />CAvr / <br />~ (877) 737-4521 <br />e-mail info~ever <br />reenanal <br />ticaLcom 'Rush: ^ less than 24 hrs, 150% ^ 1 - 2 work days, 100° <br />. {~,~ g <br />y ^ 3 - 5 work days, 50% O 6 - 9 work days, 25% <br />REPORT BY MAIL ^ FAX ~ PDF ^ EDD r~~`d~J'f-0''~ 'Subject to surcharge & exceptions noted in fee schedule. <br /> <br />J <br />REPORT CHROMATOGRAMS tg YES MATRIX ANALYSES (check anaylsis) Fora_aborafory <br />REPORT TO ~Ms) ~ ~- ~58 QR~~ <br />INVOICE TO ~ ~ ~ m h m 24 a c~v d rc .~' Wfl # ,~ ~7~~ <br />PROJECT LD. W m ° <br />m ~ m `, 2 ~ m`, m 3 ~ ~ B O.t` # <br />~ <br />~ ~ ~ •~ <br />~ <br />~ <br /> <br />~Yy <br />~ ~ <br />m .u <br />3 rn <br />C15 j~}~~J~ <br />~ ~ <br />~ <br />P.O. # <br />EA <br />L. <br />UO <br />T <br /># <br />Q <br />E~ _ <br />~ <br />w m <br />^ <br />^ ;~~ ~ <br />~ <br />°~' GS ~1) ~ ~b <br />.~I <°o m ~ a m a <br />CO <br />°y' a m 3 <br />° <br />// <br />/ <br />O <br />L <br />/ <br />/ <br />f <br />Sam ler .r ~,.- G~' <br />~ ~ <br />p ~~/4 <br />6+. ~k ~~+r1f~i L/~ ~, N <br />'- ~ <br />~ c <br />i c~ <br />V <br />a <br />a ~ ~, ~ ~ ~ o a o.° ~ ~ <br />~ . Te(np ~ <br />~ <br />w . <br />h <br />~~ <br />( <br />~ <br />Z <br /> <br />~ ~ <br />m <br />n <br />m <br />c <br />~ <br />o ~ <br />~ <br />~ <br />- <br />r4 ' <br />" ' <br />' ~ ~ _ <br />: <br /> 5 3 Q ~ Z 'c ~ y c° ~ ~ 0 0 0 3 m ~ ~ ~ CD ~ g Beefs PnesentY ~NA <br />NOTE: Identi Known Hazards Below ~~ <br />c v <br />c ~ <br />a m <br />a ~ O <br />°i m'ci ~ m <br />a - <br />n ~ <br />o ~ ~ ~ <br />~ E F o E m <br />~ ~ m _ <br />~ _ ~ ~ ~ ~ a ~ ~ <br />~ .. ~~ ~ ~' •- <br />Sartiples:Pres~f fU / NA <br />d <br />~'~ilti.l~~®~®~~®O o, <br />CU ° <br />o <br />c~ o <br />o <br />~' , <br />a <br />~ <br />u O <br />~ O m` <br />~ <br />~+ S~ ~ <br />~ r o <br />a <br />g W m <br />m o <br />p <br />~ m . <br />0 o m.y D~ <br />m- m <br />w ~ ~~ ~~, , <br />R ~ o U~ <br />m <br />~. o ° o ~ <br />~ Y~~ <br />SAMPLE <br />DATE ° ~ <br />° , ~ ~ '~ ~ o .o ,~ m <br />o :~ x a a ~ ~ ° °' ~ <br />m a m ~ ~ - ~ ~ By~:J <br />IDENTIFICATION SAMPLED TIME z ° c r <br />n o ~~ ~ rn~ v a z m ~ ~ F-°~ o` o l? Q ° a z <br />C. ~~ L i i 2 X ~ o~ <br />m 1 ~~ 2f s' zs 3 k -_x . ~z <br /> <br /> ~r zi/~ ~Z sf F .3 a <br /> <br />C j~ z~ O 9' 3 X ~ a~G <br /> <br /> <br /> IF 2L~' O °y <br />~ s 3 ~~. <br />Does this anatysis irtvoi ve property transfer? ^Yes or N ~ ``' - Sample Fraction <br />Instructions: <br />" Important Note: See reverse side hereof for terms and conditions. ~ <br />Relinquisde y: (S' ) DateRime Received b (Si Cat rtne Relinquished by: (Signature) DateRme Received by: (Signature) Date~me <br /> ~ .I ~~ f 0~ // 2 Z s- <br /> <br /> <br />