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083 CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT Page of <br />G C C C,,, l Cam, <br />Mail Original Report to: S Mail Invoice to: <br />Attn: i L- cJ 5. iz I F Attn: <br />Address: Address: <br />City/state/Zip: City/State/Ip: <br />Telephone #: Fax N: Telephone #; Fax #: <br />Email:. Project ID #; <br />P.O. #: Quote # <br />Report also by Fax PDF EDD F7 Sampler: <br />Standard 10 working days Yes No <br />UST Analyses per Fee Schedule Yes No <br />Report chromatograms Yes No Report Results by: (date)'" <br />Evergreen Analytical Laboratory MATRIX ANALY SES Rush Turn Around Time <br />4036 Youngfield Street t <br />Wheat Ridge, Colorado 80033 3 " Subject to surcharge & <br />(303) 42"021 <br />N exceptions noted in fee <br />FAX (303) 425-6854 <br />E v 3, schedule. <br />(877) 737-4521 <br /> <br />l <br />il i <br />f <br />l <br />ti <br />d <br />? rv <br />+? <br />\ <br />less than 24 hrs, +150%' <br />e-ma <br />o@evergreenana <br />y <br />ca <br />.com <br />n v <br />1 -2 workdays, +100%` <br />NOTE: Identify Known Hazards Below 0 co <br />a a ^' <br /> <br />. <br /> <br />? - V' 3 -5 work days, +50°°h <br /> <br />6 - 9 work days <br />+25% <br />SAMPLE DATE o c y c <br /> <br /> <br />` - t ` <br /> <br /> <br />1? <br />lzz- b F , <br /> <br />" Not all tests are available for <br />IDENTIFICATION SAMPLED TIME Z 0 Vr y N O N this TAT <br />I6? <br /> <br /> <br />C S.,f'1+ ?i (%4 3J J <br /> <br /> <br /> G <br /> <br /> PN ? <br /> ? vM <br /> <br />Sample Fraction a! t- G <br />Loc' cmcclo <br />Instructions: <br />Anions (check): ? Nitrate ?Nitrite ?Chloride ?Sulfate Bromide F-10•Phosphate ?Fluoride <br />Relinquished by: (signature) Date/Time Received by: (signature) Daterrime <br />For Laboratory Use Only <br /> o F 6 V 25 33 lea <br /> VININA <br />Relinquish y: {Signature) Date/Time Received by: ignature) Dater rime as (O) HeadipaC9 <br /> CIS (1) WIT1 an Its Yft <br /> Tamp C 0, i - By <br />92 <br />1 <br />wt <br />fi <br />