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1 <br />1 <br />11 <br />' o <br />3 <br />n <br />LSI <br />L <br />ADZ Laboratories, Inc.L • <br />2773 Downhill Drive Steamboat Springs, CO 80487, (800) 334-5 <br />Name: <br />Address4 <br />v S- O <br />Company: © - <br />tr.� 602 <br />E-mail: C -A 01 deS-. (abvi , <br />Telephone: V� <br />Copy of Report <br />Name: hY'7 ' , 1 <br />E-mail: KY -- Y f y� O o IC Q✓ , <br />Company: C, aldey- SSOG <br />Telephone: 3 f73Pjo DS -If <br />Invoice to: <br />Name: -:7-1,civd1 T�VTNXSI, ', <br />Address: <br />Company: } _ <br />E-mail: <br />Telephone: <br />If sample(s) received past holding time (HT), or if !insufficient HT remains <br />analysis before expiration, shall ACZ proceed with requested short <br />If "NO" then ACZ will contact client for further instruction. if neither "YES" nor "NO" is indicated, ACZ will <br />to complete YES <br />HT analyses? NO <br />proceed with the requested analyses, even if HT is expired, and data will I 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: pN N S r's pleation I State C0 Zip code Time Zone- '� <br />'1 attest to the authenticity and valid!of this sample. I understand that intentionally mislabeling the time/date/location or <br />*Sampler's Signature: tampering with the sample in anyway, Is considered fraud and punishable by State Law. <br />PROJECT•- • <br />Quote #: cl <br />fn <br />`m <br />0 <br />U <br />c <br />3 <br />PO#: I <br />Reporting state for compliance testit-n <br />Check box if samples include NRC lmaterial? <br />i5 1310 <br />c. <br />MW — <br />I, ' 5 <br />z� 6 PMH <br />GIN <br />3 <br />MN1-5 <br />It ul:3 <br />Q <br />3 <br />rv� - ko <br />s z7 ii 3 <br />3 <br />Z <br />CA VV <br />9522-711,51' io44 <br />16y\ <br />.3 1 <br />1 <br />Matrix SW (Surface Water) GW (Ground Water) WW (Waste Water) IDW (Drinking Water) SL (Sludge) SO (Soil) OL (Oil) Other (Specify) <br />NKEMARKS <br />rnQ\�S F-1eld F� <br />Please refer to ACZ's terms & conditions) located on the reverse side of this COC. <br />RELINQUISHED <br />.I <br />1_2467,89MO.6084348 White - Return with sample. Yellow - Retain for your records. <br />I <br />Page 21 of 21 <br />' D►�,t <br />