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CHAIN OF CUSTODY RECORD 1~4LYTlCAL SERVICES.AGREEtVIEIVT ** 1 ot~_ <br />CLIENTINFORMATIdN ^ Evergreen Analytical Laboratory Inc. <br />CLIENT ~~ 1 U r' ~ ~-i d~ln~t`.~Qf ~ 4036Youngfieid St. <br />ADDRESS ~ Wheat Ridge, Colorado 80033 <br />(303) 425-6021 <br />C1T1' _ STATE~~ZIP~G~~~ ~ FAX (303} 425-6854 <br />PHONE~O~- ~ ~ D ~, / (877) 737-4521 <br />~~~ ~~~ FAX .~D.j~~~1 " E-mailY!« L°.Gr ! I'E'1(~,t,, a-maii info~evergreenanalytical.com •: <br />REPORT BY~MAIL ^ FAX ~PDF ^ EDD ~ ~~~'+1 <br />Repoli Results by: (Date)' <br />Standard 2 working weeks `~' <br />UST Analyses per Fee Schedule ^ <br />' Rush: ^ Tess than 24 hrs, 150% ^ 1 - 2 work days, 100% <br />^ 3 - 5 work days, 50% ^ 6 - 9 work days, 25% <br />'Subject to surcharge 8 exceptions noted in fee schedule- <br />REPORT CHROMATOGRAMS YES <br />MATRIX <br />ANALYSES (check anaytsis) r~~Y ,- <br />~~ <br />REPORT TO~vis)~' <br />{7~rf ~~ ~IY <br />T ~~- <br />L' <br />INVOICE TO /' ~ <br />L~~ <br />l~/r.~-~ ^ c° m _z' <br />m <br />vv't.a ~`' y <br />h m a <br />~ <br />~ _ <br />- <br />/~ <br />PROJECT I.D. ~ ` r- -~~P ~ ~ <br />rn o v <br />_ <br />~ <br />~ ~ a m m iio-~ ~ f~-~ t I <br />P <br />~ <br />' <br />_ <br />P.O. # _ N/~ EAL. QUOTE #~~(CZL~ ~ ~ <br />~ " ~ ~ <br />~ ~. ~ v <br />3 rn y C1S - y. <br />^ 3 <br />m '~° ~ c t- <br />~ <br />'m ~ 3 ~3 <br />s <br />~ <br /> <br /> <br />Sampler: ~r~ G~ ~ <br />n <br />N <br />y <br />~ o <br />~ <br />t <br />,~~~~ <br />~ <br />~ a ~ o N m o° ~m ~ ° CJSC. <br />~ ~ <br />. <br />m n ~ ~ ~ ~ o za oa <br />~ Temp ~~ ,~ <br />, m T <br />, <br />NOTE: Identify Known Hazards Below ~ ~-o ~ m ~ ~,~ a c ~ m ~ ,~ ,~ °F f ~ ~ a ~, ~ " s ~~_ <br />.. <br />~ <br />tit~~i~lrttimlil~®®)~~:•~ U CO O <br />U ~ <br />> _ a y <br />~ gh ~ .~ O O O O O mH Uy ~ ~ O U <br />~ <br />O ~ p d ~ Yt ~ <br />:3' ~ ~ ~ . m ro > a7 <br />> <br />7 N ec <br />SAMPLE DATE o Y <br />c~ J ~ p ~ <br />y ~ <br />v <br />e ro ~° •i= c ~ " k = 2 ~d o a~ O .= m f- +- <br />~ <br />~ <br />IDENTIFICATION SAMPLED TIIuIE z° ~~ n o °a ~ cA'N U o a = m ~ ti +°'~ o"a = <br />~ a ~ a z <br /> o O <br /> <br /> <br /> <br />~~-0 ~ 9 <br />3 <br />~~~ ~ `# <br />~ -ate 3 - =rt.>•, . ~ } D ~ _ <br />~ w - ~ ,s ) ~zt ~ _ ~ r <br /> is <br /> <br /> <br /> .- <br /> t ~ <br /> . ,>- <br />Does this anaysis invol ve property transfer? Yes or ' N ~ ~ - ~ ~ = =':, : Sample Fraction <br /> ~ <br />Instructions: <br />" Important Note: See reverse side hereof for terms and conditions. <br />Relinquished by: (S+gnature) OateTme Receiv by: (Sign lure) ~ <br />~)4~ <br />~ ~ Date>Time <br />fa-~a3~o Relln hed by: azure) Dat une <br />f~~a3 a5 Received by: (Si nature) DatelTime <br />~ <br />~zr a3~o <br /> 12/2s~r' . <br />. <br />f ~ ~, ~ 0 fi'I0 Cc.~~ti ~ o f>' ~ ,~ ~~ ; <br />~~ ~~ <br />cot~i.-~ <br />