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AUZ Laboratories, Inc. <br />?773 Downhd1 Dnwe Steaniooet . CO 80487 (800) 334.5493 <br />Pq <br />Nanw: G 'TT So Address: l— MAI/VST <br />Co an . $R,U FUELS F094 G 5 W/ --2 2 G <br />E-mail: T / <br />"wS E E-mail: <br />lCompany. T one: <br />Name: 5AM E. Address: <br />Coff"ny: <br />phone; <br />E-mail: Tole <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 />1'l111+nwAtl N.II+Ualll rlwM mrMMnrn+a ars rt..aa. rfS n. M+ <br />♦a1+Lfala/ACl wal pacMlwan tlY wrtiM^J'tfnN yY. M.va Ml nNrnted ]OaAa N.114 WUMy.1 <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes. please include state forms. Results Will tie reported to PQL for Colorado. <br />mpler's Name Sampler's site information State <br />Zip code <br />time Zone <br />� <br />N <br />d <br />�o <br />U <br />0 <br />r► <br />PON: 0UTH E LJO` <br />Mats, for compliare testing: <br />twit a simples Incaids NRC Mosnsad niaMAa17 <br />•/3•/1 <br />L*rlu Sw (Srirtsoa W*W) Ow (iif0WW WMW) • W W (Wrta WMsr) - DW (DMkeie WMar) • SL (Skidps) • SO (Sai)• OL (OM) - Othsr (Spsoiy) <br />Please rafar to ACTe to ma 3 eondUiaw bcated on tha reverse side of this COC. <br />'abP <br />FRMAD050.02.11.11 White - Reium with sample Yellow - Retain for your records. <br />