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- ~ ChIAIN OF CLiSTODY RECORD / ~LYTICAL SERVICES AGREEINENT ** F~ot ~ <br />_ <br />cLIf=NTIN~oRMaTION Evergreen Analytical Laboratory lnc. <br />CLIENT t• I L ~ ~ l.fl~/~ ,%~ /~ <br />4036YoungfieldSt. Report Results by: <br /> <br />weeks <br />ki <br />o ~ (Date)` <br />D <br />~ <br />E <br />^ <br />P g~ ~, Wheat Ridge, Colorado 80033 ng <br />r <br />Standard 2 w <br />SS . <br />i <br />4 <br />ADDR <br />t <br />S~ ~ 303 425-8021 <br />~,~,,~~~~1~ ( ) <br />CITY ~/l L STATE~~ZIP~~ FAX.(303) 425-6854 <br />UST Analyses per Fee Schedule <br />'Rush: ^ less than 24 hrs, 150% <br />^ <br />^ i - 2 work days, 100% <br />~p <br />PHONE3~.l 'T1 ~~'~~~~ / (877) 737-4521 <br />FAX ~~3~$~3~ aE-mail ~~6tf' ~7~~~ a-mail info~evergreenanalytical.com <br />^ 3 - 5 work days, 50% <br />^ 6 - 9 work days, 25% <br />REPORT BYMAIL ^ FAX C~'DF ^ EDD /fCldl.~'6ee'~~~~ `Subject to surcharge & exceptions noted in fee schedule. <br />?EPORT CHROMATOGRAMS ~ YES MATRfX ANALYSES (check anaylsis) Fflf Laboratory <br /> :13~>' (~~ly <br /> _ <br />aEPORT TO ~Ms <br />) <br />' <br />WA <br /># ~ ~~ ~~~ <br />^ <br />NVOICE TO ~ ~ ,~' <br />v ~ <O <br />.- <br />m ~ v c <br /> <br />'ROJECT LD. Ly$~ m o <br />°' my ~ ~ °' m ~ ~ <br />~ Q a ~ o~ __ <br />?O.# EAL.QUOTE# o~ CyS~~ <br />' ~ m ~' d y ~ ~ " QO ~° ~ ~ <br />f//fe~ <br />///JJ~~/// <br />/ <br />~ <br />N y <br />m _ <br />y a y h ~' o °o ~ o-~o Q~ ~ °' Tesrtp.°fr !_:Ice_ <br />\ <br />~ <br />~ <br />~ ~ <br />,. ~ <br />( <br />p ~ ~/ l~ ~!!i./Y~l t ~Q~/.' .rJ <br />Sam ler.1'Ylb ~ ~ ~ n \y <br />- ~ . <br />a ~ <br />~ . 0 N ~ ~ ? N ~ tq " <br />/ , y ~ ~ ~ .~ <br />- Z c ~ ~ ~ ~ ~ m ~ <br />o ~ c o 0 ~° ~ ~ a Se&Ys , Y / NA <br /> <br />tify Known Hazards Below <br />NaTE: Id C <br />~~ iti 3 <br />v ..Q <br />~ ~ <br />~ ~ ~ O ~ ~' a <br />._ n. ~ 0 <br />~ co ~ E E E ~ E <br />a r ~ ~ y~ ~~ y ~ <br />.- ~ ° <br />~ ~ m ~ 1 <br />~ . ' Pres.Y,f / NA <br />en <br />C <br />~ G <br />:d m <br />.'Q1 ~, m <br />~ ~ <br />~ O <br />~ N N N.y N W <br />~ ~ <br />U V <br /> <br />~ <br /> <br />Iffi l#f ®~ ® <br />U p~ <br />G' O <br />O v <br />~ a <br />O O m ~ ~ <br />~ N R O o ~ o o o y m= m <br />~ b °p m dD a~ , M <br />C3 <br />~ <br />v Q O ~ <br />O ~... Q N ~ Y/-N/ <br />-.. <br /> <br />SAMPLE DATE <br />° 'Z <br />c ~ to = ~ c° c c <br />a~ m ~ <br />20 0 ~ ai v 2' I <br />v o m <br />m w o- a. =°~ ~ °d = <br />a m H <br />Q _ = QJ <br />Y <br />~'-_J <br />IDENTIFICATION SAMPLED TIME z° ° o - <br />r° o ` <br />~" > ~~ v o a = m ~ t"'- F-°~ ono' ~ O <br />a v a z "t <br /> <br />~ <br />~~ ~.. ~ . x <br />fD L/~' ~ <br />- <br /> ~ f <br />_~ - ~l ~,~ ~~ 3 <br /> <br />c.~- /t 22. 3n ~ <br /> <br /> <br /> <br /> <br /> v, <br /> <br /> <br /> <br />Does this analysis invo lve property transfer? ^Yes o N ~ _ ~ " ~~ ~ ~ -' Sample Fraction <br /> <br />i <br />l <br />i <br /> <br />' Important Note: See reverse side hereof for terms ano cona~uons. <br />Relinquished by: fsi Da ~ y~~~ . Rec ~ lure) Dit~me f Relinquished by: (Signature) OateRme Received by: (Signature) Date(Time <br />t {l z/ <br />