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CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** Page?ofl <br /> <br />( <br />R <br />• _ <br />ii Evergreen Analytical Laboratory Inc. <br /> <br />a <br />inaI <br />rt <br />Mail0r OrigginalR o onto: to: <br />Arin r i u.Sv1 -b tn?gr <br />^ 4036 Youngfieid St. <br />Report Results by: <br />(Date)* <br /> Wheat Ridge, Colorado 80033 Standard 2 working weeks <br />Address ^ (303) 425-6021 <br />FAX (303) 425-6854 <br />UST Analyses per Fee Schedule <br />? <br />City State Zip <br />*- ' 1001/ <br /> <br />Tel # Fax # - <br />u5, <br />`C ,r? 77) 737 -4521 <br />00 <br />E-mail <br />y info@eve reenana cal.com Rush: E3 less than 24 hrs,150% O 1 - 2 work days, <br />6 <br /> <br />250/ <br /> ? 3 - 5 work days, 50% ? 6 - 9 work days, <br />6 <br />REPORT ALSO BY ? FAX ? PDF ? EDD CONFIRMATION OF SAMPLE RECEIPT REQUIRED? 0 YES *Subject to surcharge & exceptions noted in fee schedule. <br />HtPUHt CHHUMMUGRAMS U NU <br />Mail Invoiceto: A t y"' 6,111 <br />MATRIX <br />ANALYSES (check nalysis) For Laboratory <br />C <br />&V <br />r Use Only <br />- <br />"'r <br />Attn <br /> r <br />X <br /># <br />6 <br />Address <br />an d W W.O. <br />- <br />-/ <br />y <br />v / /) <br />6 2 m C1 <br />F.# <br />O <br />m B <br />City State Zip U a <br />N . <br />. <br />CS (Oy1,an <br />? <br />Tel # Fax # <br />Project ID# v .. <br />a <br />u, m _ y t <br />p <br />40 4) <br />o s 3 o c1 GS (t)~? IAA <br />P.O. Quote <br />- <br /> <br />Sampler <br />12 <br /> <br /> <br />4) o g <br /> <br /> <br />¢ a <br /> <br /> <br />9 g+ ? <br /> <br />?. <br /> <br />z OAS co W <br />Z o'° \°' (Y Temp. °C4 / ice- <br /> <br /> <br />SealsPresentY/ NA <br />\_ <br />8 z? gv m£ <br /> <br />NOTE: Identify Known Hazards Below <br />Y o v rn O1 i .a <br />ois <br /> <br />m `l o <br />gr $ o , <br />rn q ?_?, y ,- <br />m <br />a $ 08 0' <br />x ? Samples PrBS/ N/ NA <br /> <br />HeadspaceYJN/ <br />SAMPLE DATE o <br />c v <br />` w <br />'o 0 <br />U' o a S <br /> <br />U <br />?' _m o?u <br />c ?c r <br />Flu <br />a D <br />L <br /> <br />F- <br />IDENTIFICATION SAMPLED TIME z r 3 U) o F-` :9 oa F- p r Q <br />2 m F <br />MAJ -ooN- t I 1 1 <br />t/1tiiN BOO 2 0 0 f OZ <br />•-oa3 1 1 i o <br /> <br /> <br />o t <br />014 <br /> <br />x-30 <br /> <br /> h a? C ?- <br />c?ee KE a- f-D i J j <br /> <br /> <br />Sample Fraction 6G b. E. F g ?f <br />Instructions: Fliwe f7I <br /> <br />anre V-1 Y S L <br />TT- <br /> <br />( `1 <br /> <br />-20 0 5? JAIJ <br />+* Important Note: Sea reverse side for Terms and Conditions. Anions: Bromide, Chloride, Nitrate, Nitrite, Oerhosphate, Sulfate (Circle) t. <br />RelinquisW Da ?m <br />V00 Rtu Oat ' a <br />I011 Relinquished by: (Signature) Daterrime Received by: (Signature) Daternme <br />IIINI M mm MM = MM == mm