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G11■M <br />ACCUTEST 4036 You Wheat Ridge, CO 80033 <br />303 -425 -6 [: 303. 425 -6854 <br />Accutest Job #: D35749X <br />Accutest Quote s: 0 <br />AMS P.O. #: <br />Project No.: <br />1 Client Information I <br />Subcontract Laboratcny information <br />Analytical Information <br />Name <br />Accutest Mountain States (AMS) <br />Name <br />Hazen (Radiological) <br />Radium 226/228 <br />.. - <br />,. <br />-COMM hi ' . <br />Address <br />4038 Youngfleld St. <br />Address <br />4801 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 />PhonelFax#: (303) 425 -8021; (303)425 -8854 <br />Phone: (303) 279 -4501 <br />Field ID / Point of Collection <br />Collection <br />Mask <br />Sot <br />bottles <br />Preservation <br />Date <br />Time <br />3 <br />? _ z <br />D35749X -1 <br />8/21/12 <br />10:35 AM <br />AQ <br />4 <br />X <br />-2 <br />11:45 AM <br />AQ <br />4 <br />X <br />-3 <br />12:40 PM <br />AG <br />4 <br />X <br />-4 <br />8:00 PM <br />AQ <br />4 <br />X <br />. .•. <' ( Turnaround inomlAbn <br />- , < ' <br />Data Deliverable blkxmabon <br />.,. .. ., <br />Comments /Remarks <br />®10 Business Day Standard Approved By: <br />E3 Other (Days) <br />❑ Commercial "A" El PDF <br />El Commercial "B" O Compact Disk Deliverable <br />0 Commercial "BN" Q Electronic Delivery: <br />Please use Co orado <br />regulations and RLs. <br />El Reduced Tier 1 Q State Forms <br />• Full Tler 1 • Other (Specify) <br />10 Day Turnaround Hardcopy, RUSH is FAX Data unless previously <br />approved. <br />Sample Custody must be documented below each time samples change possession, including courier delivery. <br />For Subcontract Laborartory Use Only <br />R •anqulebed by: <br />1 <br />Dab a Iles: <br />Reeked d By: <br />1 <br />Dab a 11ram <br />1 <br />Sear CA <br />R••d•pace: <br />Yes ❑ No ❑ NA ❑ <br />Reen qutid by: <br />2 <br />Dab a 1 Im•: <br />ttea•Md By: <br />2 <br />We a rem: <br />2 <br />1'reeervee where apps came: <br />❑ <br />Relleguid ed by: <br />3 <br />Dab a l Ime: <br />Received By: <br />3 <br />Dab a fens: <br />3 <br />Un ICe <br />Temperature °C ❑ <br />CHAIN CUSTODY <br />D35749: Chain of Custody <br />Page 3 of 7 <br />14 of 23 <br />• ACCUTEST. <br />D35749 `"°° "°' ° " "° <br />