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002 CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />CLIENT INFORMATION Evergreen Analytical, An Accutest Company <br />Mail Origl al Report to: Q€ ??S <br />/1? C ^ 4036 Youngfield St. <br />Attn <br />Wheat Ridge, Colorado 80033 <br />Address O C ^/\ (303)425.6021 <br />City /JAI* _5,4111we S State Ctvzip So .7 l;111 FAX (303) 425-6854 <br />Tel # o37 ! -63A3 Fax # E-mail &VNJfJWE ,(CA5 (877) 737-4521 <br />77 nfoCover8reenanal eal.com <br />REPORT ALSO BY 0 FAX QDF 0 EDD CONFIRMATION OF SAMPLE RECEIPT REQUIRED? ? YES <br />•/ <br />Page! of? <br />Report Results by: (Date)* <br />Standard 2 working weeks ? <br />UST Analyses per Fee Schedule ? <br />Rush: ? less than 24 hrs, 1509/6 ? 1 - 2 work days, 100% <br />? 3 - 5 work days, 50% AI-If- 9 work days, 25% <br />'Subject to surcharge & exceptions noted in fee schedule. <br />REPORT CHROMATOGRAMS U NO <br />Mail InvoicetoA.5-As T <br />MATRIX <br />ANALYSES (check analysis) For Laboratory <br />Use Only <br />Attn <br />Address <br /> <br />City State Zip <br /> <br />Tel # Fax # <br /> <br />Project ID# SEC/LL G tt ??{ <br /> <br />P.O. Quote <br /> <br />Sampler. Z?Y?'I <br /> <br />NOTE: ldent/fyKnown hezerr/6 Be ow <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME <br /> <br /> <br /> <br /> <br />L <br /> <br /> <br /> <br /> <br />8 <br /> <br /> <br />° <br />z° <br />m <br />'3L <br /> <br /> <br /> <br />-3 <br /> <br /> <br />$ <br />? <br /> <br />o <br /> <br />.-3 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />7 <br /> <br />a <br /> <br />7 <br /> <br />co ° <br /> <br /> <br /> <br /> <br /> <br />3 <br /> <br /> <br /> <br /> <br /> <br /> <br />' <br />o <br /> <br />d <br /> <br />d <br /> <br />?$ co <br />a) <br /> <br />m w <br />z <br /> <br />i o` ' " <br />R <br />?v-` >° $! <br /> <br /> <br />? <br /> <br /> <br />a <br /> <br /> <br /> <br />1 r\ `O \ W.O. # <br /> <br />B.O.F. # <br />_ _ O <br />t W q? W o CO CIS <br />; c4s (I)) !? n <br />S o ?, 5f a 3 / Ice - <br />ce, <br /> <br />y o Z o Temp <br />A E E E 3r SealePresentY&NA <br />Co Samples Pros. Y&/ NA <br />1 ?? ? 9 ? HeadspaoeY/N,?A <br />m x a a Rg . S q Bye/ ` <br />o a z m t°;'? o a d` <br />R b? 1-o-S ?3 rp ? o? <br />I,?/1 W2 !r r ? Z <br />7hlt!5 50C-I,0 r t n ! <br />L5 Wh770t ?t r' 6 <br /> <br /> <br /> 'e <br /> <br /> <br /> H+ l <br />Sample Fraction <br />instructions: I <br />** lmnnrtant Note: See reverse side for Terms and Conditions. Anions: Bromide, Chloride, Nitrate, Nitrite, O-Phosphate, Sulfate (Circle) <br />Relinquished by: (Signature) Datemm$/'Suh Received by: (Signature) Relinquished by: (Signature) Daterrime Received by: (Signature) Date/Time <br />