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004 <br />CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** Page-Lo <br />t? <br />CLIENT INFORMATION Evergreen Analytical Laboratory Inc. -; -P'rs <br />J l lg? <br />Mail Original Report to: <br />4036 Youngf ield St. Report Results by: (Date)" <br />Attn Wheat Ridge, Colorado 80033 <br />Address , (303) 425-6021 Standard 2 waking weeks 4 <br />FAX (303) 425-6854 UST Analyses per Fee Schedule Q <br />city State _ Zip (877) 737-4521 - Rush: O less than 24 hrs, 160% O 1 - 2 work days, 1000/0 <br />Tel # Fax # E-m I e-mail Info@levergmwanalytlcal,com <br />Q 3.5 v+ak days, 501/6 ? 6 - 9 work days, 250/6 <br />REPORT ALSO BY ? FAX ? PDF O EDD 5ce- vc1Q v^ 5XE, CL *Subject to surcharge & exceptions noted in fee schedule. <br />REPORT CHROMATOGRAMS U YES <br />Mail Invoice to: I.," 6"11 ? MATRIX ANALYSES (Check anaylsis) <br />" <br />vISV <br />r C <br />Ca f <br />p <br />%l V <br />Attn <br />Address p <br /> p Kg <br /> <br />City State Zip > C1? 4 h' <br /> Y <br />Tel # Fax # <br /> <br />Project ID# <br />P.O. Quote L rs : <br /> <br />Sampler w <br />m? <br />a V <br />is t <br />S. <br />e <br />NOTE: Identify Known Hazards Below .2 <br />< <br />SAMPLE DATE / r` a <br />IDENTIFICATION SAMPLED TIME a °- <br />IM - O U/1010 V 1130 a- Ill l 1 <br />1111 <br /> <br />Yrl - O 3 (315 t ,? .?? <br /> <br />MK) -04 <br />W4,0 11 A <br />Z <br />O r <br /> <br /> <br /> <br /> <br /> ?dkt ti _ <br />. <br /> 5 <br />I ON <br /> 1 <br /> <br /> <br /> <br /> <br />sis invol <br />es this anal <br />D <br />ert <br />ve <br />ro <br />transfer? GI <br />Yes or ? <br />Sample Fraction <br />1.4 <br />y <br />o y <br />p <br />p <br />Instructions: ?V^ Sa r f <br />*? Imeerfant Note- Saa reverse side hereof for terms and conditions. L( ..x.• 11 /0 -7:.n 4 RZ) t) 652 iH/I /1. I *!r h nm q, <br />Relinquished by: (Signature) Date/flme <br />-71010 <br />0,1311"'16. Recehred by: aitue) <br /> <br />1AZ t)a?lrime elinqufshed by: (Signature) t]ate/rUrle Received by: (Signature) Date/Tlme <br />I IIII Iwo M = M = M = = M = M = = = = M