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ACZ Laboratories, Inc. •' <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334- <br />Name: W1116,14X e55ek55MA16 Address: INE <br />Compan L <br />E-mail: r --06;7-2 <br />Copy of Report <br />Name: 4.6k04AI -5Wee c E-mail: ` , <br />Company, Telephone: 3173-4.4,2— <br />Invoice to: <br />Name: DI.t) lei TIA D Address: JL[ <br />Company 1U4 [.O 3D2 - <br />E -mail: e e Telephone: 3 <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" then ACZ will contact client for further Instruction. N neither "YES" nor "NO" is Indicated, ACZ will proceed with the requested analyses, awn H HT Is expired, and data will be qualiMd <br />Are samples for SDWA Compliance Monitoring? Yes I I No <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name: ampI is Site Information State Zip code 9636,1 Time Zone L <br />•1 attest to the authenticity and validity of this sample. I understand that intentionally mislabeling the time/dale/location or <br />*Sampler's Signatu tampering with the sample In anyway, is considered fraud and punishable by State Law. <br />PROJECT•R• • e (attach 1i5t or use quote nuruber) <br />Quote #: <br />PO#: _ <br />Reporting state for compliance testing: p <br />Check box if samples include NRC licensed material? <br />11Q� <br />ra • � • it <br />0150314- W1 Ni h5 i3i; 20 &Y 3 X <br />u - W3 ,► 13:49 i9a <br />3 <br />tt -- W4 14,'PO @w <br />3 <br />X <br />X <br />-P t• 15".2-5 &0 <br />3 <br />XC <br />Matrix SW (Surface Water) GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • SL (Sludge) SO (Soil) - OL (Oil) • Other (Specify) <br />XEMARKS <br />))LL SA'X MPDS /3i2c iZ4Ld) P:l [ TC,Q gS /V GCS <br />/)V,9LvR 1k)E-,r,-9zZ <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED BY: D• D• <br />t <br />UMAXDM4930131 White - Return with sample. Yellow - Retain for your records. Page 12 of 12 <br />