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984 CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** Page Iof?_ <br />?LIENTINFORMATION / Evergreen Analytical Laboratory Inc. <br />Mail Original Reportto: ? <br />4036 Youngfield St. Report Results by, Jk I'm l^. dl` (Date)' <br />Atin 'nn ^ Wheat Ridge ColoradoSW33 <br />Address A, (303) 425-6021 Standard 2 working weeks !?? <br />FAX (303) 425-6854 UST Ana"es per Fee Schedule ? <br />City State _ Zip (877) 737-4521 <br />mail info?eve ? * Rush: ? less than 24 hrs, 1500? 1 -2 workdays, 100% <br />Tel # Fax # E-mail e- r9reenanalyt.cal.com <br />? 3 - 5 work days, 5016 ? 6 - 9 work days, 250% <br />REPORT ALSO BY ? FAX ? PDF ? EDD <br />'Subject to surcharge & exceptions noted in fee schedule. <br />nCrvn+ vnnv1nr%1%JW PVVK7 u Iw <br />Mail Invoice to: <br />MATRIX <br />ANALYSES (check anaylsis)? <br /> 1 <br />Attn <br />Address <br />City State Zip Q,m <br />F - <br />% <br />Tel # Fax # <br /> <br />ID# ? <br />-Z <br />Project ( <br />P.O. Quote t2 m ? <br />O L <br /> <br />a <br />3 ri <br />$ efheNrkXf f.NA <br />Sampler N „t <br /> <br />NOTE: Identify Known Hazards Below F2 a <br />1 <br />y!N fNA <br />SAMPLE DATE <br />° <br />n S gy , <br />IDENTIFICATION SAMPLED TIME z a o <br /> <br /> <br /> <br /> <br /> i <br /> <br /> M J. <br /> <br /> 'n - <br /> <br /> <br />1 P n <br /> <br />Does this analysis Invol <br />I <br />ve property <br />transfer? ?Yes or 17N <br />7-, <br />" ^? <br />= ; > Sample Fraction <br /> <br />Inctrnrttinnc- 01 - L' '1.1?? 7-7-77-a-, , // 4M_ L /e + rAn .-J.- ?]. ?r _ (.,_. /? Awn L.7 <br />•• Important Note: See reverse side hereof for terms and conditions. rap ?/i/ie i-r. / j ;,c.l?r?,.n?? ?o ??. C ?t?.. ?. //J. /% 1l„c I?i? <br />Relinquished by: (Signature) DateT-me Received by: (Signature) t e?J Relinquis by: (Signature) <br />v bate/Time rived by: (Signature) DateMrns <br />