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O <br />..o <br />N <br />3 <br />U <br />w <br />O <br />C <br />-1 <br />L = -r, <br />ACZ Laboratories, Inc. C O • <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 -5493 <br />zT .. <br />Name:, a.1''C- �1(1mns <br />Address: HH Cn 6, Ste, 300 <br />Com an &166e)- ` <br />9 60 <br />E -mail: V ,���1 t1 c ;��Q� <br />Telephone: c3 G 0 — 0�•�O <br />Copy of Report <br />Name: S Y' h - <br />E -mail: <br />C2Me22L-L)U l s C.L S I <br />Telephone: <br />lnvoic�e <br />Name: �� QI�``1�C -1 <br />Address: yL� <br />Company: 0 ( y- A<-,so GI t-t-s <br />LEl �leuoocC Lo <br />E -mail: 11G��1'1\rl 01 i <br />Tele hon : � q — 051A0 <br />If sample(s) received past holding time (HT), or if insufficient HT remains <br />to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />If "NO" then ACZ will contact client for further instruction. N neither "YES" nor "NO" is Indicated, ACZ will <br />proceed with the requested analyses, even if HT is expired, and data will be qualified <br />Are samples for SDWA Compliance Monitoring? <br />Yes No <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name aS Sampler's site Information <br />Stater Zip code`' Time Zone <br />Check box if observe Daylight Savings Time <br />PROJECT INFORMATION <br />REQUESTED <br />Quote #: N(&2r <br />L <br />Po #: j ,53 - 1�0,I 4 L c7 <br />m <br />Reporting state for compliance testing: � <br />0 � -�" �� �,� <br />Check box if samples include NRC licensed material? <br />C <br />f(1UJ <br />1 l90o <br />l� <br />X <br />Y� <br />7(IFID'WON <br />5 <br />l� <br />" <br />Jc <br />X <br />10 35 <br />l� <br />3 <br />x <br />x <br />rn u) -. <br />I0� a o 9L 5 <br />LA) <br />X <br />X <br />11'1 - <br />Ig 1a014 13 5o <br />G <br />3 <br />a <br />1g0014 15L <br />to <br />I /I- <br />x <br />w- 15 <br />.YY) of -�,� <br />ac�l 1350 <br />Matrix SW (Surface Water) GW (Ground Water) WW (Waste Water) DW (Drinking Water) SL (Sludge) SO (Soil) OL (Oil) Other (Specify) <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED <br />19 0(Im5� <br />I I <br />r <br />FRMAD050.12.12.12v White - Return with sample. Yellow - Retain for your records. _z1_ v �V <br />