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®AC ® 4036 Youngfield St., Wheat Ridge, CO 80033 <br />303-425-6021 FAX 303-425-6854 <br />Accutest Job 8: D286•2X <br />Accutest Quote s: <br />AMS P.O. s: <br />Project No ; <br />Mann Client Information MEM <br />Subcontract Laboratory Information <br />Analytical information <br />Name <br />Accutest Mountain States (AMS) <br />Name <br />Hazen (Radiological) <br />co <br />g <br />N <br />E <br />cc <br />' <br />_. <br />�Artlm;mta' -� <br />Address <br />4036 Youngfield St. <br />Address <br />4601 Indiana Street <br />City State Zip <br />Wheat Ridge, CO 80033 <br />City State Zip <br />Golden CO 80403 <br />Send Report to: Tiffany Pham <br />Any questions contact Shea Greiner <br />Conhch <br />Sample Management <br />Phone/F=1: (303) 425 -6021; (3034254854 <br />Phone: (303) 279.4501 <br />Field ID / Point of Collection <br />Collection <br />Matrix <br />bottles <br />Preservation <br />Date <br />Time <br />22 <br />1 2 <br />z <br />D28612X -1 <br />10/13/11 <br />11:35 AM <br />AQ <br />4 <br />X <br />-2 <br />12:30 PM <br />AQ <br />4 ' <br />X <br />- 3 <br />3:00 PM <br />AQ <br />4 <br />X <br />-4 <br />6:00 PM <br />AQ <br />4 <br />X <br />Turnaround Information <br />... "�t r: d; <br />, : :y ,., .,, <br />.., �.:' -4 <br />Data Deliverable Infonnalion <br />- '"� . '+"'` , .' <br />Y "', N <br />Comments Remarks <br />010 Business Day Standard Approved By: <br />■ Other (Days) <br />❑ Commercial "A- ell PDF <br />• Commercial °B° • Compact Disk Deliverable <br />❑ Commercial MN" p Electronic Delivery: <br />Please use Co orado <br />regulations and RLs. <br />■ Reduced Tier 1 • State Forme <br />• Full Tier 1 • Other (Specify) <br />10 Day Turnaround Hardcopy, RUSH is FAX Data unless previously <br />approved. <br />Sam y. • ustody must be documented <br />1 � "..:. / : <br />2 <br />below each time sam <br />4JJ�.��IL'i(!fi'� <br />- - - <br />• cha • • • .- , ndudin a courier <br />2 T <br />delivery . <br />.r� <br />2 . <br />For Subcontract <br />Laborartory Use Only <br />Yes ❑ • No ❑ NA ❑ <br />.._ _. _ app"= <br />❑ <br />raunquwrw by: <br />3 <br />wa a 7 mw: <br />ROWAN my: <br />3 <br />Date armor: <br />3 <br />on ice <br />Temperature °C ❑ <br />CHAIN OF CUSTODY <br />D28612X: Chain of Custody <br />Page 3 of 7 <br />• 8of12 <br />• ACCUTEST. <br />D28612X " " ° "° ' " <br />