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002 <br />CLIENT INFORMATION <br />Mail Ori anal Report toy <br />Attn J_'G... M r 1 C <br />CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />Gaws 4) + 1N5 Evergreen Analytical, An Accutest Company <br />Page-of. <br />n 4036 Youngfield St. Report Results by: (Date)' <br />?e D ^ Wheat Ridge, Colorado 80033 Standard 2 working weeks <br />(303) 425-6021 <br />City uK Q State Zip FAX (303) 425-6854 UST Analyses per Fee Schedule [a <br />} L,Y? ? 737-4521 ' Rush: ? less than 24 hrs, 150% ? 1 - 2 work days, 100% <br />Tel # Fax # E-mail )4, t' o IC N evergreenanalytical.com <br />REPOR ALSO BY ? FAX ? PDF ? EDD • CD ? 3 - 5 work days, 50% 13 6 9 work days, 250/6 <br />REPORT CHROMATOGRAMS ? NO CONFIRMATION OF SAMPLE RECEIP REQUIRED? ? YES 'Subject to surcharge & exceptions noted in fee schedule. <br />Mail Invoice to/:D MATRIX ANALYSES (check analysis) For Laboratory <br />Attn J Lt c .k- G toy Usse?e Only <br />AddressL 14?1) o a? z ^ (o v ' L17?? <br />/?., ? d m = ? a W.O. # <br />city ?1 1 L StateC,CL_Zip? P10 ' v _ a a ;, `O m B.O.F # <br />.'Q P t :8 <br />Tel 10 - , l Fax # N if R . <br />'s m v v cis O / <br />co t6 <br />A,41'% ra If, 01i Project ID# _ <br />J1 7 >,v w 3 m SZ o a m N p o ?_ i. ? (I)) <br />ar m 3 w o ?+ <br />P.O. Quote GG ov 0 m as ? " o` c°o D Za O? d Temp. Sampler R. ?0.? c o a u '-, o m `D \ m m Hlm__ <br />2 c m r o 3'a g a Seals PresentY&JNA <br />NOTE: Identify Known Hazards Be%w o co ?G_ <br />S' ? $ Samples Pres.Y / N <br />c. o O O m r r° a> cv R.h % HeaYw/NA <br />a •c o v) ? c ? o •0 CO m w 0°a N-5 v `O <br />SAMPLE DATE c - °' M m o s` ?°, £? w a Q. y az o <br />= 14U IDENTIFICATION SAMPLED TIME z 3 to o = 1- Q By ? <br />?r? II ;N ?? u?? k dl <br />(I <br />Sample Fraction <br />Instructions: Scrvd ? )ls a W ' alzk GlQr? <br />** Important Note: See reverse side for Terms and Conditions. nninnc• <br />Relinquished by: (Signature) Datemme <br /> <br />-o9 <br />a4Jwoe Received by: (Signature) Dat ime <br /> <br />!0 2?f f Relinquished by: (Signature) Date rime Received by: (Signature) DeteRme <br /> s:? 5--p <br />