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004 <br />CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT , <br />CLIENT Mlnil r1rie1 RnnnATnfinalnnl naM rttn- 6: i Evergreen Analytical Laboratory Inc. Page?of___[__ <br />_ ,ri S.? t r s-+i•• -/? 4036 Youngrield 5t. Report Results by: Q I Vi L 'I ` (Date)` <br />Attn ^ <br /> <br />Address <br />^ Wheat Ridge, Colorado 80033 <br />425-6021 Standard 2 working weeks ? <br /> <br />City State <br />Zip 425-6854 UST Analyses per Fee Schedule ? <br />_ <br /> <br />Tel # -Fax # <br /> <br />E-mail (977) 737-4521 <br />' Rush: ? less than 24 hrs, 150% ? 1 - 2 work days, 100% <br />e-mail iModevergreenanalytkal.com <br />REPORT ALSO BY ? FAX ? PDF 0 EDD ? 3 - 5 work days, 50°k Q 6 - 9 work days, 25°1/° <br /> Subject to surcharge & exceptions noted in fee schedule. <br />REPORT CHROMATOGRAMS ? YES <br />Mail Invoice to: MATRIX ANALYSES (check anaylsis) For Laboratory <br />Attn Use 0* <br />Address <br />W.O. #tD?'?" <br />. <br />City State Zip m o <br />o, y a <br />- <br />' Z3? <br />B,O F rP <br />Tel # Fax # ( C18 (O} <br />Project 10# o <br />N -- C45 <br />2 <br />0 <br /> <br />P.O. Quote <br />m <br />° m a v rerrr? ac <br />. <br />1 <br />- -...... <br />Sampler c 01 ? "¢ ? Sea1f3 Fresertl Y / / fVA <br />NOTE: Identify Known Hazards Below ?? <br />c o a v <br />c ;; 5r3riiplesl.N.1 <br />v <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME z° o W <br />O <br />r <br />? 1 Q <br />By <br /> o <br />It .U -t~ 14 ?- a i? ?'c? <br />1 <br />14- <br />1 <br />11 <br />t <br />I <br />I <br />©j <z: <br /> <br />W L, 0 4- 142D <br />C) LN <br /> <br /> <br /> <br /> <br /> <br /> <br />Does this analysis invol ve property transfer? ?Yes or U N 01 .,0 <br />. <br />, Sample Fraction <br />Instructions: ? <br />S feit? '?%5. ?,.. 14\94A <br />& , o C+ <br />? .,; LAA, ht ( <br />. <br />: . V <br />Important Note: See reverse side hereof for terns ana cordtions. 51 i? Leika 1•:t t` 1 <4 Fvc ,M i ?, a o ,it,. 1, r L+1 ? h', ii /' a F d"'! f P M 1 <br />Relinquished by: (Signs@ye) <br />l <br />" DateTme Received by: (Signature) <br />.J Datenirr a elinquistled by: (Signature) <br />I Datefri Jeceived by: (Signature) DataTiirne <br />? <br />lvl'olllk <br />Ile <br />+ ? <br />r <br />zz <br />? r