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Laboratories, Inc. C l �-� 7 • <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Report <br />Name: a Address: Q Be)x/52 <br />Company: i L -L Mme—S, S <br />E-mail: 12{ Telephone: — qR 7:— [j— <br />Copy Report <br />Name: P al Ls E-mail: 1-01349,91 t f <br />Company: lTelephone: <br />Invoice a <br />Name:(Z)L �T /�/ Address: Q <br />Company: rvaLlb / L L MJA/191.5, h/JC C© 80562 <br />E-mail:Telephone: 72 <br />If sample(SI 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. It neither "YES' nor "NO" Is Indicated, ACZ will proceed with the requested analyses, even It HT Is expired, and data will be qualified <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes, please includS AAte forms. Results will be reported to PQL for Colorado. <br />Sampler's Name: pler's Site Information State CV Zip code_j!7,3Q,322Ume Zone <br />•1 attest to the authenticity and validity of this sample. I understand that mislabeling the time/date/location, or tampering <br />'Sampler's Signature: with the sample In anyway, Is considered fraud and punishable by State Law. <br />PROJECT•- • • U EST E a (attach list or use quote number) <br />Quote #: <br />PO#.a �] <br />Reporting state for compliance testing: LD o <br />Check box if samples include NRC licensed material? c <br />® b a —' 411104- 15;35 a <br />3 <br />X <br />0429 M 5 2& 14t,65 6 <br />3 <br />v 6 2,e -- 3 °L9v i ►f 14-.'W C <br />3 <br />X <br />ro 14 eta 2f3 -" C li /4; 52 b <br />A <br />Matrix SW (Surface Water) • GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • SL (Sludge) • SO (Soil) • OL (Oil) • Other (Specify) <br />REMARKS <br />s prJ'1'I P/_0 AAF-��7%c�/ r=/L jc_2 /� S /U16�L�2_t <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINOUISHED DA • DA <br />l�rz5 S., h1crAt u 02107/0.1//4t <br />L f §W 0FR00h 11A3 White - Return with sample. Yellow - Retain for your records. Page 12 of 12 <br />