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DZ Laboratories, Inc. L lq27743 <br />D•' <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Name: Address: Q, 2 <br />Company: u_ l Ilii , I MPAI50z <br />E-mail: r , ' Telephone: g <br />Copy of Report <br />Name: '012I>DN E. IE -mail: t r <br />Company: e: chi <br />Invoice to: <br />Name: K A . Address: , a t0 k 15.93 <br />Com any: c_ , L1_ 05 JN C GOA IV <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 />It 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 aspired, and data will be qualltied <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes, please include ptptjkforms. Results will be reported to POL for Colorado. <br />Sampler's Name: mpler's Site Information State Cd Zip code, Time Zone&b 7— <br />•1 attest to the authentlelty and validity of this sample 1 understand that mislabeling the time/da */location, or tempering <br />*Sampler's Signature*with the sampb In anyway, Is considered fraud and punishable by State Law. <br />PROJECT IN• • REQUESTED (attach list or use quote number) <br />Quote #: d <br />PO#: <br />for testing: p <br />Reporting state compliance <br />U J <br />Check box if samples include NRC licensed material? 5 <br />• ��1111millivit- PRN <br />WL b'. w ? <br />IV 4o,626 -- 2 it CSL <br />X <br />X <br />di #o 6 29 -- 3 if /3-755 60 <br />3 <br />X <br />-;K- <br />2 — tl A: 6 O <br />'01406293 <br />3 <br />X <br />X <br />0 140b 26 -- <br />3 <br />17C <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 />L L QOM Pt /24 UJ j IL T'614'-> /9LS IV -6: , <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELIN0.1-11SHED BY: D• D• <br />4 t'� T ki/aAF910 / if,lS <br />Lli§W-PPRO24,41*7 White - Return with sample. Yellow - Retain for your records. Page 13 of 13 <br />