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ACCUTE , s 4036 Youngfield @ 80033 <br />�+ 303- 425 -6021 F. <br />Accutest Job #: D22645X <br />Accutest Quote #: <br />AMS P.O. #: <br />Project No.: <br />Client Information 1 <br />Subcontract Laboratory Information <br />Analytical Information <br />Name <br />Accutest Mountain States (AMS) <br />Name <br />Hazen (Radiological) <br />gross alpha/beta + TS <br />radium 226/226 <br />Comments <br />Address <br />4036 Youngfield St. <br />Address <br />4601 Indiana Street <br />City State Zlp <br />Wheat Ridge, CO 80033 <br />City State Zip <br />Golden CO 80403 <br />Send Report to: Tiffany Pham <br />Any questions contact Amanda Kissel! <br />Contact <br />Sample Management <br />Phone/Fax #: (303) 425 - 6021;(303)425 -6854 <br />Phone: (303) 279-4501 <br />Field ID / Point of Collection <br />Collection <br />Matnx <br />#of <br />bottles <br />Preservation <br />Date <br />Time <br />I -mu <br />CONF1 <br />VoSZF� <br />auoN <br />D22645X -1 <br />4/13/11 <br />11:00 AM <br />DW <br />5 <br />X <br />X <br />-2 <br />12:00 PM <br />DW <br />5 <br />X <br />X <br />-3 <br />1:45 PM <br />DW <br />5 <br />X <br />X <br />- 4 <br />12:00 AM <br />OW <br />5 <br />x <br />X <br />i Turnaround Information <br />Data Deliverable Information <br />Comments / Remarks <br />010 Business Day Standard Approved By: <br />0 Other (Days) <br />O Commercial "A" Q PDF <br />0 Commercial "B" - Compact Disk Deliverable <br />0 Commercial "BN" ED Electronic Delivery: <br />Please use Co orado <br />regulations and RLs. <br />0 Reduced Tier 1 Q State Forms <br />• Full Tler 1 • Other (Specify) <br />10 Day Tumaround Hardcopy, RUSH is FAX Data unless previously <br />approved. <br />Sample Cuatod must be documenttedd bb�eloow each time samples change I ssesalo, including courier delivery. <br />For Subcontract Laborartory Use Only <br />/ . / <br />f�//i %A' %,MWLSWM <br />, <br />• <br />Yes s ❑ e- <br />C) El No NA <br />- enqu- -• <br />2 <br />•a me: <br />• ecav -• - <br />2 <br />rs:: me: <br />2 <br />- reserve•w ere app ca e: <br />❑ <br />Relinquished by: <br />3 <br />. a e Siena: <br />- ecelvedBy: <br />3 <br />., a Slime: <br />3 <br />On ice <br />Temperature °C ❑ <br />CHAIN OF CUSTODY <br />D22645X: Chain of Custody <br />Page 2 of 6 <br />• A 7of11 <br />• Accu-rEST> <br />