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2007-02-02_HYDROLOGY - M2004078 (3)
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2007-02-02_HYDROLOGY - M2004078 (3)
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Last modified
8/24/2016 3:16:34 PM
Creation date
3/18/2008 4:24:44 PM
Metadata
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Template:
DRMS Permit Index
Permit No
M2004078
IBM Index Class Name
HYDROLOGY
Doc Date
2/2/2007
Doc Name
Draft water quality baseline report (part 3)
From
Brad L Hagen
To
DRMS
Email Name
CBM
Media Type
D
Archive
No
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CHAIN OF CUSTODY RECORD /ANALYTICAL SERVICES AGREEMENT ** <br />CLIENT INFORMATION Page ~ of~ <br />t Evergreen Analytical Laboratory Inc. <br />CLIENT~i ~} 1 \ ~ S ~~,~,,:"~ Q ,5 ^ 4036Youngfield St. Report Results by: (Date ' <br />;~ ) <br />ADDRESS f . ~ , ''//L~f!?~ (D (? ^ Wheat Ridge, Colorado 80033 Standard 2 working weeks <br />CITY l{~1 ~ 1f~ STATE~_ZIP ~S ~ ^ (303) 425-6021 <br />UST Anal es r F S h <br />PHONE `3C?~'~3 ~ ~ /~~-f (n FAX~Ct.3 -~ 3,~ •^ ~ E-mail ~~' <br />REPORT BY~'vrjA1L ^ FAX~DF ^ EDD CyL?f ~~~''f~' ~c~ <br />REPORT CHROMATOGRAMS ~ES MATRIX <br />REPORT TO f r s) w <br />INVOICE TO S r..Q ~ "' <br />~~ <br />PROJECT LD. L-G ~~r (,~~~QS o,~ <br />f6 U <br />U U _ <br />P.O. # EAL. pUOTE # v, <br />Sampler: ` ° ` ~ ~ ~) ~ -." ~ ~'~ <br />NOTE: identify Known Hazards Below <br />~~~~i~~~~~~~ <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME <br />~~Lti .. <br />~~ <br />~~~ <br />o ~ n. <br />a~ m <br />c ~~ ~ ~ <br />U ~~ o rn <br />sE rn <br />o ~~ ~ ~ <br />z° °_~ c° O <br />5~~,~ <br />.~~ <br />'3d ~ ~ <br />~~ ~ ~ <br />(~C~ 1 p ~ <br />~~ ~ `~ <br /> <br />this analysis involve property transfer? <br />instructions: -~~ " ~ /1^~ ~ ` <br />" Important Note: See reverse side hereof or terms and conditions. <br />Relinquished by: (Signature) DateTme ~ Received by: (Si, <br />!I'/~C <br />ll0 ~~ l/~J11~7~/~ _ ~ , „ <br />FAX (303). 425-6854 ys pe ee c edule ^ <br />(877) 737-4521 'Rush: ^ less than 24 hrs, 150% ^ 1 - 2 work days, 100% <br />e-mail info~evergreenanalytical.com ^ 3 - 5 work days, 50% ^ 6 - 9 work days, 25°/ <br />'Subject to surcharge & exceptions noted in fee schedule. <br />ANALYSES (check anaylsis) <br /> i <br />: ,: <br /> <br /> <br />n ~ I i. <br /> <br />~i1~-~ i <br />For. Laborato. ry <br />Use Only <br />-Temp. °C~ / Ice/" <br />Seais Prese~7 N / NA ` <br />Samples Pres~1 N / NA <br />Hea ce Y /`,~ NA . <br />By/ <br />`:Gj <br />o' <br />.O~ <br />Sample Fraction <br />by: <br />Received by: {Signature) I DatelTime <br />_-- - • • <br />
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