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ICiZ Laboratories, Inc.�� �a <br />Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Name- / jiPil, Alidt <br />Company: <br />ie/ ne— <br />E-mail: rtj <br />" h uSk1(Cj: CCAAi <br />Copy of Report <br />Name: R n <br />/VC_/'cc `4 <br />Com any: <br />.1 <br />Address: r;,lO GtJjS cin <br />6. nn)sao o �Z3o <br />Telephone: (?,7t)--3/0 amu_ <br />E-mail. TOS c -sem ^ wmeru.//esc�<_eS eCICAk <br />Telephone: Zit— 2537 <br />Name: r G✓ en 5 Address: m <br />Com any: as yj ; n, %�vt � 6A r/4 0G-11 <br />E-mail: f - rtS e fn v-1rf9L1x•C004 Telephone: 'gsy"/!9— -1yCO <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. 11 neither -YES" not "NO" Is indicated. ACZ will proceed with the requested analyses, even it NT 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: rfer's Site Information State Gem Zip code 0 Time Zone %AT <br />•1 attest to the authenticity and validity of this sample. I understand that mislabeling the time'date/locstion, or tampering <br />•Sampler's Signat with the sample In anyway, is txnsedered fraud and punishable by State Law. <br />Quote #: ie2i�t Shr�aty 'S1li6c �;jl(% a <br />m` <br />PO#: <br />.W <br />Reporting state for compliance testing: <br />0 <br />U <br />Check box if samples include NRC licensed material? c <br />arta . _ •► �_ a 7t <br />a <br />i <br />—ta <br />—=o <br />C <br />Matrix <br />IIS Cn%fl <br />1 /y, 6W <br />Sw <br />'y /y,,q5— <br />S[.+✓ <br />(Surface Water) • GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) SL (Sludge) - SO (Soil) • OL (Oil) • Other (Specify) <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED BY: DATEMME RECEIVED BY: <br />L1 ytSlJti-14Ut5 61.632 White - Return with sample. Yellow - Retain for your records. Page 26 of 26 <br />