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@ ;; rrI 1 j:% U* UN Of CUSTODY <br />iiiiiiiiiii'i raJ• -' Accutest Job #: 012932 <br />®ACCUTEST 4036 Youngfield St., Wheat Ridge, CO 80033 Accutest Quote #: <br />303-425-6021 FAX: 303-425-6854 AMS P.O. #: <br /> Project No.: <br />Client Information Subcontract Laboratory Information Analytical Information <br />Noma Name <br />Accutest Mountain States (AMS Hazen (Radiological) <br />Address Address o <br />N <br />4036 Youn field St. 4601 Indiana Street m <br />City State Zip City State Zip ° <br />Wheat Ridge, CO 80033 Golden CO 80403 <br />Sand Report to: Tiffany Pham Concoct: N m <br />Any questions contact: Sample Management m m <br />L <br />Phone/Fax #: (303 425.6021; (303 425-6854 1'hone: 303 279-4501 tNV 2 <br /> Collection P res erv atio n E <br /> of o o y i? m ° <br />Field ID / Point of Collection Date Time Matrix be <br />bontes = z = = i C7 Comments <br />D12932 -1 4/30/10 12:30 PM AQ 6 5 1 X X <br />-2 4130/10 10:30 AM AQ 6 5 1 X X <br />-3 4130/10 11:30 AM AQ 6 5 1 X X <br />-4 4/30/10 12:00 AM AQ 6 5 1 X X <br /> <br /> <br /> <br /> <br /> <br />• `:._ Tumaround Information .: Dat a Delive rabl e Inf orm atio n ?. Comments / Remarks <br />Ole Business Day Standard Approved By: 0 Commercial "A" o PDF Please use Colorado <br />M Other (Days) M Commerclal "B" Q Compact Disk Doliverable regulations and RLs. <br /> Commercial "SN" [:] Electronic Delivery: <br /> 13 Reduced Tier 1 State Forms <br />10 Day Turnaround Hardeopy, RUSH is FAX Data unless previously ? Full Tier 1 Other (Specify) <br />approved. <br />Sample Custod must be documented below each time sa <br />mples change possession, including courier delivery. For Subcontract Laborartory Use Only <br />ea s <br />- <br />^? ?' 20?V p <br />-07 yy--?? <br />I - - lV Yes ? No ? NA ? <br />1 1 <br />e v qU a y: a7 ,T 1 ryes 2 cene y: 2 e ime: / <br />e: <br />reserve?w ere pp"... <br />2 r <br /> <br />uis a y: <br />3 mq <br />a Imo, cene y: <br />3 a e <br />m . <br />3 e <br /> <br />Temperature"C ? <br />W <br />_.a <br />y?rR <br />D12932X: Chain of Custody <br />Page 2 of 6 <br />®® 7 of 11 <br />®ACCtJTEST <br />D12932.