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ACZ Laboratories, Inc. )0 6 • ' <br />9 <br />(/�+ <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5433 6 <br />-aa <br />Name: 9T- 42 Address: �r 42t x 2.3 <br />Company: �. C1rMaAzW Z <br />E-mail: aIgmTelephone- <br />Copy Report <br />Name: (jQ p G E-mail: 1041- &,44LI�fim <br />Company: e RAbn MIu4ijaTelephone: — — <br />Invoice <br />Name: a Address: 2 <br />Company: "' ✓r02 <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 procedd 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: 4 W -4 /s'1 ampler's Site Information State t2o Zip code 602o2—Time ZoneIV 22S� <br />'1 attest the authenticity and validity of this sample. 1 understand that intentionally mrslabeling the time/dats/location or <br />to <br />'Sampler's Signature:. tampod to with the sampM h anyway, is considered fraud and punishable by Stats Law. <br />ReJECT INFORMATION ANALYSES REQUESTED (attach list or use quote number) <br />Quote #: L <br />E- <br />PO#: <br />r^ <br />Reporting state for compliance testing: � v 1 <br />e <br />Check box if samples include NRC licensed material? c V2 <br />a• at <br />0) 4692 ✓ ✓ <br />a --MGI <br />Matrix SW (Surface Water) • GW (Ground Water) WW (Waste Water) • DW (Drinking Water) SL (Sludge) - SO (Soil) - OL (Oil) • Other (Specify) <br />�/� f3orrL C� � �•I�YCf� As ��L�Lf � k� < <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />L21MOODP 4PIC11fM White - Return with sample. Yellow - Retain for your records. /, (Pad* -Vkbf 12,95Y <br />