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1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />i <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />i <br />1 <br />1 <br />1 <br />1 <br />ACZ Laboratories, Inc. L <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 - 5493 <br />Name: til'f1: r(ri _ -FLn r V 1 n< I I Address: <br />Name: `In ✓Yi k Y Yin #-1M .V 1 I I E -mail: <br />Name: ' Aciaress " ) <br />Company: <br />E -mail: Telephone — 15q- a <br />If samples) recelved p t hot ing time (HT), or if insufficient HT remains to comp ete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />M -M, Ilwn = wo saMaM .00M for fweu 1.11 — bn. M r. Mar `YES- aw mW la Indlcalad. ACZ we /roe"d wen the McYaared *Nn%W% gran If aT Is eaphad. and d.M wit 1e tuou141 <br />Are samples for SDWA Compl nce Monitoring? ye j No <br />If yes, please Include state forms. Results will be reported to POL for Colors o. <br />sampieYs Name: Sampler's site Information State: Zip code Time Zone <br />Check box If observe Daylight Savinga Time <br />/UO <br />Page 26 of 26 <br />Quote #. <br />>n <br />c <br />c <br />i7 iC <br />{ �� <br />t��• <br />l,� ,, <br />ao #: 0( /0, --A llv�- <br />Reporting stale for compliance testing: <br />Check box if samples include NRC licensed material? <br />-\ aoc <br />x <br />x <br />V - V-) <br />X <br />X <br />0140 <br />x <br />It IQ agJ3 la3o <br />111 ILI 3 <br />x <br />- L,l <br />III 15 6-IiIA'3 DqL40 <br />I X <br />m - <br />L- Dcl 30 <br />G. <br />x <br />X <br />X <br />20 <br />It 1` <br />Matrix SW (Surface Water) • OW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • St. (Sludge) • SO (Soil) . OL (Oil) • Other (Specify) <br />670"h <br />REMARKS <br />0 <br />0 e �Or`npkib WQM Ftdd kik id WMV\ C�ppro��t�aC� <br />Please refer to ACZ's t rrrt & o d don the reverse side of this COC <br />�— RELINQUISHED s DATEJIME RECEIVED : <br />tin <br />FRMADD50.12.12.12 White - Return with sample. Yellow . Retaln for your records. <br />/UO <br />Page 26 of 26 <br />