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005 <br /> CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />CLIENT INFORMATION - <br />M <br />l R <br />il O <br />i <br />i •?- 1 Evergreen Analytical Laboratory Inc. <br />J I * <br />? <br />` 3 c© ?? Page--of <br />a <br />g <br />na <br />r <br />eport to: _ <br />? <br />!l <br /> <br />Attn 0}leld St. <br />^ 4036Youn Repoli Results by (Date) <br /> <br />Address Wheat Ridge, Colorado 80033 <br />^A? (303) 425.6021 <br />Standard 2 working "peeks <br />? <br /> <br />City FAX (303) 425-6854 <br />State <br />Zip UST Analyses per Fee Schedule ? <br /> <br />Tel # _ <br />(877) 737-4521 <br />Fax # E-m 'I e-mail Info@evergreenonalytical.com • Rush: ? less than 24 hrs, 150% ? 1 •2 workdays, 1001/a <br /> <br />REPORT ALSO BY 13 FAX <br />O PDF El EDD <br />Q V o 1e ? <br />'? 51 <br />5c <br />' ? 3.5 work days, 500/6 <br /> <br />' O 6.9 work days, 25% <br /> r, <br />!r <br />(1r <br />? ? <br />?eG? Subject to surcharge & exceptions note d in fee schedule. <br />Mail Invoice tae TVI-4 61, 1( MATRIX ANALYSES (check anaylsis) <br />v <br />Attn E fits V'i' r <br />Address <br />wo <br />J <br />~ <br /> <br />City State -ZIP <br />_ <br />T? <br />Q! <br />N <br />Tel # Fax # S ° fides '` <br />Project ID# <br /> <br />P.O. Quote y <br />tp <br />(? ? <br />l'! <br />w e Y Y`S s' 'l <br />T <br />Sampler a c r, i <br /> <br /> <br />NO <br />TE: Identify Known Hazards Below <br /> <br /> <br /> <br />ji <br />45 C <br /> <br /> <br />p ZQ <br /> <br /> <br />> <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME z g a ,-, <br />MW-oZ 7/10 10 1130 12- <br /> <br />VYl " D 1315 ku l <br /> <br />f 1714. ! ( J?'.'f7 .Si . <br />.`' <br /> t <br /> <br /> <br /> <br /> <br /> 1 li <br /> <br /> <br /> <br /> <br />Does this analysis Invol ve property transfer? ?Yes or ? N A <br /> <br />(t ' ' <br />' <br />T <br /> <br />K <br /> <br />R <br /> <br />A <br /> <br />le Fraction <br />Sam <br /> „ k p <br />Instructions: >°iGA ,n r e 'r -• rmponam note: see reverse sloe norm for terms and conations. /•/I Lt I"% 1( Aj -7Un 4 A73 - ^A57 JAY) A . ir y, e- <br /> <br />Relinquished by: (Signature) DaWTkne Received by: ature) Datelnme elinquished by: (Signature) Datamrm Received by: (Signature) Datamr" <br />` ? <br /> -71010 t <br />