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ACZ Laboratories, Inc.•' <br />2773 Downhill Drive Steamboat Springs, CO 80487 (8 00) 334- 954 3�UO <br />e <br />Address: SRy: <br />7ae: <br />' t 1 ILl f <br />ti t Telephone: � —Q <br />Copy of Report <br />Name: E-mail: i <br />Company: Telephone: 2 <br />Invoice a <br />Name:1. ' Address: . , N <br />ff ,, <br />Company* L 1.� [__ <br />UL <br />E-mail: F I Telephone: —,O <br />If same (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 VIII contact client for further instruction. II neither "YES" nor "NO" Is indicated, ACZ will proceed with the requested analyses, even If HT Is expired, and data will bs qualMad <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: s 1 Sagiplees Site Information State_ Zip code1 Time Zone M AT <br />'I aNest to the authenticity and validity of this sample. I understand that intentionally mislabeling the tiriw/dateAocation or <br />•Sampler's Signature: tampering moth the sample In anyway, Is considered fraud and punishable by Stats Law. <br />PROJECT•- • e (attach list or use qijote oi-iber) <br />Quote #. m +— <br />PO#: ," f <br />for testing: r i c 11 TT�� <br />Reporting state compliance p <br />Check box if samples include NRC licensed material? c <br />_ 1• 2' � <br />X <br />X <br />m1. 11>Lr L 6- ? <br />3 <br />A <br />X <br />tOther(Specify) <br />Matrix I SW (Surface Water) GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • SL (Sludge) • SO (Soil) • OL (Oil) <br />REMARKS <br />ALL 5,4MP>Lz Ape RAWj rLme 1 j IV,9� �6, <br />AVALY' F PM, t 5SAt- -b LCM�i1L . <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED BY: D• D' <br />3?11 /Sr v, a,pc� 3 •10 r <br />L241Arg9�Q��)IQ1 White - Return with sample. Yellow - Retain for your records Nage i2 or 12 <br />