Laserfiche WebLink
004 <br />CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />ELtENT1NFORMATION <br />Mail Original Report to: Y)ti Evergreen Analytical Laboratory Inc. l <br />e Page 1 of?_ <br />Attn 4036Youngfield St. Report Results by: <br />Wheat Ridge, Colorado 80033 (Date)* <br />Address / ` (303)425-6021 Standard 2 working weeks U <br />city State _ Zip FAX (03) 425-6854 UST Analyses per Fee Schedule 0 <br />Tel # Fax # E mayl <br />info 7-45 45 vergreenanalytical.com * Rush: 13 less than 24 his, 1500/° <br />_ e-mail 3 <br />0 1 - 2 work days, 100% <br />REPORT ALSO SY Q FAX O PDF ? EDD ('J 1- 'U 3 - 5 ?? ?Ys. ?% <br />SC " <br />v C S <br />' ?. 6 - 9 worts days, 25% <br /> <br />REPORT CHROMATOGRAMS OYES ? <br />?\? <br />Subject to surcharge a exceptions note d in fee schedule. <br />Mail Invoice to: Toi 61 it MATRIX ANALYSES (check anayisis) <br />t`orl tpry <br />Attn ?EK ?C tl r C?Ns? _ <br />? Use 01* <br />Address ro <br />-?quo <br />a U ? <br />W <br />O <br /> <br />City State Trp_.. _.. <br /> <br />Lm a) <br />, <br />. <br />. <br />p a t <br />Tel # Fax <br />P U <br />p <br />?) ` <br />' <br />roject ID# <br />P.O. Quote - ' <br /> <br />Sampler v) b <br />m <br />a °C? t [oe <br />r <br /> <br /> <br />NOTE: identify Known Hazards Below <br />c n <br /> <br />° °D a a h <br />a Seals PieseM Y ! NA <br /> <br />Sarrpiris tyres +(i N NA <br />SAMPLE DATE <br />IDENTIFIC a =`? <br />c? _? h <br />- <br />' HeabpG ytN/AEI( <br />ATION SAMPLED TIME <br />O <br />F sv <br /> <br />1NIV?-02 II o t7_1 1 <br />. <br /> <br />- L I <br />MW-O a ! t3f5 t i l l i t I 1 I i t : ,. <br />w <br />Does this analysis involve property transfer? DYes or UN <br />Instructions: ft%p,- 4le 5 CLO r We <br />e r <br />'• Important Note. See reverse side hereof for terms and conditions. ?t wt I 7 Sn o65 <br />Relinquished by: (Signature Date/rime Recei77 efure) Date/The e0nquished by: (Signature) Datertii <br />-?/„ ©g 7101,