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MN <br />Accutest Job #: D36098X <br />Accutset Quote #: 0 <br />:le- ACC ST 4036 Youngfield SL, Wheat Ridge, CO 80033 <br />303 -425 -6021 FA 303-425-6854 <br />AMS P.O. #: <br />Project No.: <br />• °r ^; ^ +1 Client Information -:6i'ti r ; ' <br />Subcontract Laboratory Information <br />Analytical Information <br />Name <br />Accutest Mountain States (AMS) <br />Name <br />Hazen (Radiological) <br />Radium 226/228 <br />°• . <br />Comments <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 />Contact <br />Sample Management <br />Phone/Fax it (303) 425-6021; (303)425 -6854 <br />Phone: (303) 279 -4501 <br />Field ID / Point of Collection <br />Collection <br />Matrix <br />a <br />Preservation <br />Date <br />Time <br />i <br />CONK <br />i <br />i <br />D36098X -1 <br />7/3/12 <br />10:15 AM <br />AQ <br />4 <br />X <br />- I Turnaround Information <br />'-- - . <br />Data Deliverable Information <br />„ <br />Comments / Remarks <br />®10 Business Day Standard Approved By: <br />• Other (Days) <br />• Commercial "A" MS PDF <br />I. Commercial "B" D Compact Disk Deliverable <br />Please use Co orado <br />regulations and RLs. <br />• Commercial! "BN" • Electronic Delivery: <br />IN Reduced Tier 1 • State Fortes <br />10 Day Turnaround Hardcopy, RUSH Is FAX Data unless previously • Full Tier 1 MI Other (Specify) <br />approved. <br />S ay • Custod must be documented <br />/ <br />below each time samples change • ossesslon, includin • courier <br />//r/ <br />delive . <br />cm <br />1 - /fil <br />For Subcontract <br />Laborertory Use Only <br />'ea. spawn <br />Yea ❑ No ❑ NA ❑ <br />- n•ec - , <br />2 <br />y, - .. me <br />- r .,,..,, r =y: <br />2 <br />. <br />2 <br />-reserve. w are •p ca . e: <br />0 <br />Rermquunee by: <br />3 <br />Dad 6 1 Ime: <br />RedelVad 6y: <br />3 <br />D•W& lime. <br />3 <br />(7n ice <br />Temperature •C ❑ <br />CHAIN OF STODY <br />D36098: Chain of Custody <br />Page 3 of 4 <br />12 of 35 <br />• ▪ ACCIJTEB1 <br />