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Q <br />=a <br />c <br />-- m <br />-- _t <br />CZ Laboratories, Inc. a ��6� • . <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 5493 <br />Name: /v5 t�k% Address: SlG Gf%js on <br />Company: iGc/ nL l rws o .D I'Z3o <br />0 <br />E -mail: t,5 �1' R cfuS! -lift %:rC fCrNA Telephone: <br />Copy of Report <br />Un n /u L r4. E-mail: p n Pr n2�5,u l �t>•� eS rt Oz'l <br />Fame <br />Il'rr <br />3 �Telephcine: 45 <br />Company: � <br />Invoice to: <br />Name: r G ✓ enS Address: .Z Z77 kw r klu m Ot: <br />v t l nr_ Ybt�Gci (. �rL y <br />Company: :T ' ,al <br />E -mail: k5 er\-i>h v-: Jru , i,x ;eoM Telephone: gS6-49 ° wco <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />If "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 No <br />If yes, please Include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name: r, er's Site Information State Cif Zip code Time Zone <br />•1 attest to the authenticity and validity of this sample. 1 understand that mislabeling the timeldateliocation, or tampering <br />•Sampler's Slgnatu with the sample in anyway, Is considered fraud and punishable by State Law. <br />PROJECT • • <br />Quote #: <br />to <br />PO #: <br />ca <br />Reporting state for compliance testing: W r- <br />0 <br />V <br />Check box if samples include NRC licensed material? c <br />Eel kq �* <br />top <br />Matrix SW (Surface Water) GW (Ground Water) • WW (Waste Water) • DIN (Drinking Water) • SL (Sludge) • SO (Soil) • OL (Oil) • Other (Specify) <br />,(�Va/M� c-. O•� �'li� r�•HVl /7�>Gj /'�!✓l/' /n fr /�� rio/► LvG`� /`���t✓'er� <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED D. <br />/.• <br />L"I ytSUtS -941 ab"I11L2 White - Return with sample. Yellow - Retain for your records. Page 26 of 26 <br />