Laserfiche WebLink
0 04 CHAIN OF CUSTODY RECORD / ANALYTICAL SERVICES AGREEMENT ** <br />CLIENT INFORMATION Evergreen Analytical Laboratory <br />Time@ <br />Mail Original Report to. Quality Data on 1 <br />Attn 4036 Youngfield St. <br />??'?j Wheat Ridge Colorado 80033 <br />Page_?of? <br />_ (Date)' <br />Address I C.. <br />/\ (303) 425-6021 Standard =? <br />=?e ? <br />City State Zip FAX (303) 425-6854 U <br />peF <br />dule ? <br /> <br />Tel# Fax# - <br />(877) 737-4521 <br />E-mail e-mail info@evergreenanalybeal.com • Rush: ? less than 24 hrs, 150% ? 1- 2 work days, 100% <br /> <br />REPORT ALSO BY ? FAX ? PDF ? EDD <br />FAXED CONFIRMATION OF SAMPLE RECEIPT REQUIRED? ? YES ? 3 - 5 work days, 500/6 ? 6 - 8 work days, 25°k <br /> <br />0e0n0r nu13^KAArnn_ewue M- Subject to surcharge 6 exceptions noted In fee schedule. <br />Mail invoice to: ?i?M <br />Attn MATRIX ANALYSES (check a aylsis) For Laboratory <br />Use Only <br />Address <br />city State Zip <br /> <br />Tel # Fax <br />Project ID# <br /> <br />P.O. Quote <br /> <br /> <br />a <br /> <br />N <br />$ 04Y111- <br />r ( WO _-- <br />,, ..? B.O.F # L 9 <br />US (0??? <br />cis (I ZdZ ( I 1ytJ <br /> <br />r ? ` Temp. -c-LI/ ice <br />Sampler <br /> <br />NOTE: Identify Known Hazards Be%w <br /> <br /> <br />SAMPLE DATE <br />IDENTIFICATION SAMPLED TIME <br /> <br />g?M <br />0 <br /> <br />is 9 <br /> <br /> <br /> <br /> <br />o <br />d <br /> <br />; <br /> <br />V <br /> <br />! <br />L r Saab ProeerxY (' NA <br />, :? : a sert!s N / w? <br /> <br />_C HeadspepY./.N&. <br />•??r 'V?1• ?? ,?V i.'C s <br />• <br />O 1 <br />?'A W 0 c) -31 1 1471 4 OY ... <br />IW k <br />? \ y <br />/I <br /> P <br /> 6 <br /> <br /> 4 A. <br /> <br /> <br /> <br />Does this analysis involve property transfer? ?Yes or UNo <br />LI <br />± <br /> <br />4 N <br /> <br />V1 <br /> <br />71- <br /> <br />J <br /> <br />Sample Fraction <br />Instructions: ?' (-A 5;'a wo Ps w 6A tv% l 77-7 17; A-41? 71 77 t ., <br />IRIpeRanti NOW See reverse Side heteof for terms arid CONditions. <br />Relinquished by: (Signatur) <br />* D +el" iimei ` Received y: (Signaru Dafg/Tim Relinquished by: (Signature) DateMme Received by: (Signature) Dat&Time <br />'00 13 Y3? <br />