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004 (} f Y <br />CHAIN OF CUSTODY RECORD /ANALYTICAL SERVICES AGREEMENT **` - <br />??_ <br />CLIENT INFORMATION !)) Evergreen Analytical Laboratory Inc. Page of <br />Mail original Report to: ..-? t <br />4036Youn9r reldSt. L f { <br />Report Results by: V-1 1, (Date)* <br />Attn Wheat Ridge, Colorado 80033 Standard 2 working weeks ? <br />Address /? (303) 425.6021 <br />City State Zip FAX (303) 425-6854 UST Analyses per Fee Schedule ? <br />Tel # Fax # E-mail (8ma) I info@eveigreenanalyticai.com rgreenanalytical.c?m + Rush: ? less than 24 hrs, 150% ? 1 -2 work days, 100% <br />O 3 - 5 work days, 50% ? 6 - 9 work days, 25% <br />REPORT ALSO BY ? FAX ? PDF 0 EDD Subject to surcharge & exceptions noted in fee schedule. <br />Mail Invoice to: v V <br />Attn MATRIX ANALYSES (Check anaylsis) For LaboratorY <br />Use O* <br />Address <br />City State Zip <br />Tel # Fax # <br />rnd WO.d i? <br />i B,QF.# 2 <br />t ' r CJE (©) F'tit <br /> <br />Project ID# <br /> <br />P.O. - Quote_.. <br /> <br />Sampler a, <br />C] <br /> <br />o m <br /> <br /> <br />ry <br /> <br />m <br /> <br />a <br />"? <br /> <br />L <br />us <br />.. <br />? 7en9C 2• J Ica <br /> <br />SeedsFressoty/1/NA <br />NOTE: Identify Known Nazardy Below <br />SAMPLE DATE <br /> <br />IDENTIFICATION SAMPLED TIME <br /> <br />L) <br />c <br />z ono <br />co <br /> <br />° o o <br /> <br /> <br />rn a <br /> <br /> <br />O r <br /> <br />lu <br /> <br />E d <br /> <br /> <br />Q San,pteswrea?rtN?NA <br /> <br />.Y./Nl.p(?. <br />y. p <br /> <br /> <br />? sal - ; C., A= 14 2D <br />9' <br />! <br />1 <br />f <br />t <br />! t <br />b 3 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Does this analysis invol ve property transfer? ?Yes or ?N (?: F Sample Fraction <br />Instructions: 1.5 o\-C, 1A. 3jtr ,Yw jlL( ' <br />•' Important Note: See reverse side hereof for terms and oonditions. 'ry'p -ve-, I I ; ' F Y C ^ (,. 0 0 le. V i o S h.-zt i 44- C Q c If rki Relinquished bey: (SignahVa) DatelrimReceived <br /> by: {Sign/a/fu/re)J Z elinquisted by: (Signature) DateTme [eceived by'. (Signature) Datelrune <br /> <br /> <br />? r