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1 <br />1 <br />1 <br />1 <br />11 <br />1 <br />it <br />r� 1 <br />�y <br />III <br />L� <br />AUZ Laboratories, Inc. • <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 -549 <br />Name: (?L1 ^(�.. (��� 111 Address: <br />Compan : C, Ir 662, & C, 'A ;3e 6 a V 0 Ac 3L U <br />E -mail: QV" x' Telephon LO - 01N Q <br />Report Copy of <br />Name: ('�,V I E -mail: 5MOV C Pic 0 �� <br />Com any: � 0 R,r : ' - ' fj T <br />Invoice Address: <br />Name: '�t�' . G.Y�•� LA LA U1'11 oyl N ! ; <br />Company: • � 1 • r b a (VV.U-5 w ECC+(- L, `_4u <br />eoill Telephone: ` j (} OCO V <br />If sample(s) received past ho ding time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />N "NO" then 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• L pier's Site Information State ct Zip code Time Zone m�'% <br />h attest to the authenticity and validity of this sample. 1 understand that intentionally mislabeling the dme /datenocatlon or <br />'Sampler's Signature: i tampering with the sample in anyway, Is considered fraud and punishable by state Law. <br />PROJECT •- • <br />Quote #: O <br />d <br />PO #: 1 - Q-49� / U <br />Reporting state for compliance testing: p <br />Check box if samples include NRC licensed material? <br />t <br />- Z <br />2. <br />11112.6 '''uti0 <br />Caw <br />V5 <br />�d I <br />- *75 <br />t2 0 <br />U - <br />7M7-irix 7 SW (Surface Water) GW (Ground Water) • WW (Waste Water) - DW (Drinking Water) • SL (Sludge) SO (Soil) • OL (Oil) • Other (Specify) <br />IREMARKS <br />� li iP lease refer to ACZ's terms & conditions located on the reverse side of this COC. <br />.: ■• ■ DATEJIME <br />( <br />AM I + t %�/ i <br />L220MMM114156 White - Return with sample. Yellow - Retain for your records. Page 21 Of 22 <br />