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CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />CLIENT INFORMATION Accutest Mountain States Pa <br />e r of <br />L <br />E ? <br />?e <br />+T <br />?' <br />? g <br />vlt <br />lt <br />Mall Original Report to: *-c+R <br />j <br />, <br />O• <br />.f <br />®® <br />?Zfe-r• eQ <br />?^ 4036 Youngfield St. <br />QAC <br />P TE .. Wheat Ridge, Colorado 80033 Report Results by, (Date)' <br />r r1GI^ <br />Address 2-1273 I <br />• " • , ., ... (303) 425-6021 Standard 2 working weeks <br />!! <br />City • n•'J StateC O 20 fl (SDZ.. FAX (303) 425-6854 UST Analyses per Fee Schedule ? <br />Tel # `7V 75`J /0709 Fax # / (877) 737-4521 <br />E-mail 2,Ce '3ttK lfea'-?)•cae-nail info®accutest.com <br />/ *Rush: ? less than 24 hrs. 150% <br /> <br />d <br />? ? 1 - 2 work days, 100°/ <br /> <br />1 <br /> <br />REPORT ALSO aY ? FAX ? PDF ? EDD FAXED CONFIRMATION OF SAMPLE REC Pi REQUIRED? O YES <br />REPORT CHROMATOGRAMS ?YES 3-5work <br />ays, 50% ? 6-gwork days, 25 <br />% <br />Subject to surcharge 8 exceptions noted in fee schedule. <br />Mail invoice to: J?au-sue cr-s <br />AIM «. M ATRIX ANALYSES (check anayl sis) :.For Laboratory <br />Only <br />.I si <br />Address <br />City State Zip <br />Tel# Fax# <br />w <br />d r <br />3 WO:'8 <br />p t),O;F# '. CVG <br />GS( ..,'... Ge( <br />Project ID# <br />P.O. Quote <br /> <br />Sampler <br />in N 3 <br /> <br />`o <br />m? ? <br /> <br />a <br />a <br /> <br />n <br />3 I tl v as p)--[w'tf! , <br /> <br />`?lf p ::. Temp. ^C 3.'7'! Ice ? <br />Seals <br />PteserW/N/NPi <br />1 _ + <br /> <br />NOTE: /dentifyKnown HazardsBe%w <br /> <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME <br /> <br />(3 <br /> <br />z° <br />Pa a <br /> <br />o <br /> <br />0 w <br /> <br /> <br />o \ <br />\ T <br />\ ?* <br /> <br />I? Samples PM Y'/.N/NA <br /> <br /> <br /> <br />r <br />vV 1b51- i23L- ? X I 1x1 0k <br />L- s ? ?i: /3t>c GZ <br /> <br /> o?- <br /> <br /> <br /> <br /> <br /> <br /> <br />Does this analysis involve property transfer? OYes, or ONO <br />Sample Fraction <br />Instructions: <br />- important Note: See reverse side hereof far terms and conditions. <br />Rellnquishe y: (Signature) Date/1'lme <br />r?,2Slro Recsh%dby;(Sigmture) Dateirim I1,1,quiheJby:(S1gntu-) Datafr-e Received by: Sig?re <br />( ) DateTme <br />? J <br />j J <br />llee U G3 Q <br />D10582: Chain of Custody <br />Page 1. of 1 <br />®® 14 of 31 <br />12AccLJT6ST. <br />D10582 Labnr.:tories