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I ACZ Laboratories, Inc. CHAIN of CUSTODY <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-54 3 <br /> Report to: <br /> Name: a(`a /44,r kin 3 Address: /Oil >�I-V D 303 <br /> I <br /> Company: Go!clef IBS,or_i a Lake c c�c c)c G C� 0226 <br /> E-mail: SiLtir}Cirt,1�rpl�Pt. C...011.1 Telephone: 003) l csa- O J L/() <br /> Copy of Report to: <br /> IName: Scr c. Meta E-mail: S ! ""Q]� , C w1 <br /> Company: 610 t pF,R_ A-�5 0C I+7ZL5 Telephone: (1 To) `7 gI 3 g 5 7 <br /> IInvoice to: �t \ <br /> Name: 5AJl 'lark►�Kj Address: 4T hI,it B]vU St--e3jc' <br /> Company: A Older 4`33c‹:/a1+5 Like ke L ( N C O �d <br /> IE-mail: SA cif{(i $ L3 C'l c1 P-( s C OM Telephone: 3) q go °-( 0 <br /> If sample(s)received paTSt holding time(HT),or if insufficient HT remains to complete YES �,/‹, <br /> I analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> N"NO"than ACZ will contact client for further Instruction.If neither'YES"nor"NO"is indicated,ACZ will proceed with the requested analyses,even if HT is expired,and data will be qualified <br /> Are samples for SDWA Compliance Monitoring? Yes I I No 1,>'0■I <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> I Sampler's Name: S/{t/ Sampler's Site Information State C-0 Zip code Time Zone 141S1-- <br /> 'I attest to the authenticity and validity of this sample.I understand that Intentionally mislabeling the time/datellocaiion or <br /> *Sampler's Signature: tampering with the sample in anyway,is considered fraud and punishable by State Law. <br /> I <br /> PROJECT INFORMATION _ ANALYSES REQUESTED(attach list or use quote number) <br /> J m Quote#: 4 0 L C. WI - t�Ct,) 86 3,2 4 4 <br /> I <br /> PO#: I LOo l59 i' ' ' <br /> Reporting state for compliance testing: Al O o <br /> Li-6.6 box if samples include NRC licensed material? c <br /> SAMPLE IDENTIFICATION DATE:TIME Matrix <br /> 1 ailtj --1 ii-it-/4 I. 00 tw 3 •X <br /> WI () —Z 11-u-14 15©o (;Itv 3 <br /> I M (.v -3 11-0-12/ I HOC �w 5 In W ti-a-P1 Sf 13 32 ' w 3 <br /> fit w ,- S ii-u-/ii 112 5 &t3J 3 X <br /> . Mw G 1/4-14 toog Gi ) 3 •?‹ <br /> P /1, W--1 11-11-/4 0122 ib' co 3 <br /> rvt-w-- /5 f-)l-14 12.0.5- ln&/ ' <br /> Fo. NI,(2) -gyp i-11-i — 0 3 X <br /> Itc..3 <br /> Matrix SW(Surface Water) GW(Ground Water).WW(Waste Water)•OW(Drinking Water)•SL(Sludge)•SO(Soil)-OL(Oil) Other(Specify) <br /> — <br /> F ) e je ;f];-efeø'\ &,t 6;55,310,e) ruteeek -1- icy&-E <br /> r <br /> y <br /> IPlease refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY: DATE:TIME RECEIVED BY: DATE:TIME <br /> I !OP f /1-11-i' IC 3 5 I,- ._ ,i/,d1-/ /4i_ <br /> IL2FIFYIPRPPMf3146 White-Return with sample. Yellow-Retain for your records. Page 23 of 24 <br />