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993 <br />CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT <br />G L C ?? C ?-(z? Cam, <br />Mail Original Report to: /- S Mail Invoice to: <br />Attn: W I L. cJ S K 1 Attn: <br />Address: Address: <br />City/State/Zip: City/State0p: <br />Telephone #: Fax #: Telephone #: <br />Email:. Project ID #: <br />P.O. #: <br />Report also by Fax PDF EDD F7 Sampler: <br />Standard 10 working days Yes No <br />UST Analyses per Fee Schedule Yes No <br />Report chromatograms Yes No Report Results by: <br />Fax Ill: <br />Quote III <br />(date)'" <br />Evergreen Analytical Laboratory MATRIX ANALYS ES Rush Turn Around Time <br />4036 Youngfield Street t <br />Wheat Ridge, Colorado 80033 Subject to surcharge & <br />(303) 425-6021 a/t <br /> <br />? N excepti <br />in tee <br />noted <br />h <br />l <br /> <br />FAX (303) 425-6854 <br />` <br />t <br />e. <br />sc <br />ed <br />u <br />(877) 737-4521 w ra <br />; less than 24 hrs, +150%' <br />e-mail info@evergreenanalytical.com 3 a; <br />C u <br />1 ` 1 -2 work days, +100%* <br /> o y m . _ y? 3 -5 work days. +50% <br />NOTE: Identify Known Hazards Below c ?, 0 _ b 6 - s work days, +25% <br />SAMPLE DATE O c y o F Not all tests are available for <br />IDENTIFICATION SAMPLED TIME Z o C Co N this TAT I y <br />'p .., - fl C S?? Its' l yl? <br />? r <br /> <br /> <br /> <br /> <br /> G <br /> <br /> 19'j,? c <br /> <br /> <br /> <br />Sample Fraction <br />a! <br />L <br />1 7ZW CC, <br />Loc ` <br />Instructions: <br />Anions (check): ? Nitrate ?Nitrite ?Chloride ?Sulfate Bromide D O-Phosphate ?Fluoride <br />Relinquished by: (Signature) Date/Time Received by: (Signature) Daterrime <br />? ` For Laboratory Use Olnly, <br />o <br />D T - 25'33 <br />v <br />M <br />/ <br />tom' .o <br />w. <br />sealsPms?ent <br />V <br />n <br /> B.O.F. # 2 Z '7y 3 SamPles Ptaaerved YMfNA <br />Relinquish y: (Signature) Datefrime Received by: ignature) Datefrlme C/S (O) Headepaos rkg1YC <br /> CIS(]) loe AN <br /> Temp C By <br />Page of <br />1 <br />?.1 <br />P-6 <br />fi <br />r