Laserfiche WebLink
ADZ Laboratories, Ince • <br />Drive Steamboat Springs, CO 80487 (800) 334 <br />Name: K EC/A/ Address: . Q <br />Company: 11,oipIl. U L d2 <br />E-mail:Tele hone: — <br />Copy of Report <br />Name: JLv g V gE-mail: ' <br />Compan a Telephone: Q — — <br />Invoice to: <br />Plaavla: LLLe Address: P .2 <br />Company: I <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 />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 Vale jorms. Results will be reported to PQL for Colorado. <br />Sampler's Name: ampler's Site Information State Zip code &&& Time Zone Ad= <br />'1 attest to the authenticity and validity of this sample I understand that Intentionally mislabeling the dmeldatellocafion or <br />*Sampler's Slgndtur@: ..paring with the sample In anyway, is considered fraud and punishable by State Law <br />PROJECT•• •REQUESTED <br />Quote #: d <br />PO#: , <br />Reporting state for compliance testing: p <br />Check box if samples include NRC licensed material? 0 1 r^S <br />1 p— I v <br />tt — 2 n /2.'d W <br />W3 <br />i2:4 <br />3 <br />A — I I aid <br />MMS 41110 <br />Matrix SW (Surface Water) GW (Ground Water) WW (Waste Water) • DW (Drinking Water) - SL (Sludge) SO (Soil) OL (Oil) Other (Specify) <br />REMARKS I <br />hL SPrM PL- J---- 18,OTTL,S G�QL- tP.-�1�l � �L7E,� AS NEL <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHEDD• • D• <br />1 34 t oft:.' ' <br />16 ,. <br />dam 1• I' <br />L2M9D39-9f9fJd6 White - Return with sample. Yellow - Retain for your records. Page 14 of 14 <br />