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CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** Page _ot__ <br />?8WENTINFORMATION // Evergreen Analytical Laboratory Inc. <br />Mail Original Report to: G_,t' 11th <br />4036 Youngfield St. Report Results by: ?? Vtw G1 (Date)' <br />Attn T Inn e., r 1 ^? Wheat Ridge, Colorado 80033 <br />Address /w\ (303)425-6021 Standard 2 working weeks w_' <br />FAX (303) 425-6654 UST Analyses per Fee Schedule ? <br />City State _ Zip (877) 737-4521 • Rush: ? less than 24 hrs, 150% ? 1 - 2 work days, 100% <br />Tel # Fax # E-mail e-mail info Oevergreenanalytical.com c <br />? 3 - 5 work days. 50% ? 6 - 9 work days, 25 /o <br />REPORT ALSO BY ? FAX ? PDF ? EDD 'Subject to surcharge & exceptions noted in fee schedule. <br />REPORT CHROMATOGRAMS U YES <br />i <br />MATRIX <br />ANALYSES (check anaylsis) ?' , <br />Mail Invo <br />ce to: <br />Attn <br />Add W.4 <br />ress ?n <br />City Zip State mo <br />m v <br />2? r`` ){9 <br />`' ??? <br />Fax # <br />Tel # $'c`S t <br />1y1?" """ ` <br />_ <br />Project ID# <br />V p <br />P.O. Quote <br /> <br />Sampler a Y j ^ ? s <br /> 10 <br />NOTE: Identify Known Hazards below gQ c ` ` , Y/Nft41 <br /> <br />SAMPLE DATE <br />??, <br />5 S . <br />sy 1 <br />IDENTIFICATION SAMPLED TIME zo coo o <br /> o <br /> <br /> <br /> <br /> <br /> r <br /> <br /> Y N,_ <br /> <br /> <br /> ?(! rTs S{?Y <br /> .pt <br /> <br /> 7_n <br /> 1 4_. <br /> <br />sis Invol <br />Does this anal <br />ve property <br />transfer? DYes or ?N 777 - <br /> <br />. <br />. <br />Sample Fraction <br />y 5 <br />r u. <br />Instructions: 0?; -el?ks fo? All VN ixI5 4 report l?isSeLA'1'r 44'&(s ? <br />.. I... ....rtam# Lim- Can ravarea QUIP haranf fnr Prms and mndifims. lean %AA- 1.-. _ / ) :.c• L A.-^,-A Al J- 16 1,,- 'i? I, -L /1J•// <br />Relinquished by: (Signature) Date/fune Received by: (Signature) ot ne Relinquis by: (Signature) <br />v Oate/Time R ived by: (Signature) Date(Ttrrre <br />I