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ACZ Laboratories, Inc. •' <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 t <br />Name: a Address: /672-3 <br />`LL <br />Com any: L Z <br />E-mail: r t Telephone: - Jr <br />Copy of Report"Xae <br />Name: E-mail: <br />Company: LL C Q _T <br />Invoice a <br />Name: Address: Q �J <br />Company: NG AWAr 71 Aa 54 2- <br />E -mail: Telephone: - <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 />N "NO" then ACZ wilt contact client for further Instruction. N neither 'YES- nor "NO" Is Indicated. ACZ vAll 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: SO& er's Site Information State_ Zip code Bo3o2rime Zone <br />'1 attest to the authenticity and validity of this sample 1 understand that intentionally mislabeling the timeldateltocation or <br />"Sampler's Signature:44 tampering -th the sample In anyway, Is considered fraud and punishable by State Law <br />ANALYSES REQUESTED <br />PROJECT• • <br />Quote <br />PO#: <br />Reporting state for compliance testing: p <br />U <br />Check box if samples include NRC licensed material? c <br />V� <br />• B <br />D <br />Matrix ISW (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 />L2��36APQ@4.8@0988 White - Return with sample. Yellow - Retain for your records. Page 8 of 8 <br />