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ACZ Laboratories, Inc. / <br />2773 Do11 Dn"e, sienahoat sprint, CD 10137 1x00)334.3493 L <br />xa6 <br />Narne: Eric Simms <br />4� -3 <br />� Y ( 11 I \ t, I <br />'7' <br />( 1 SIOI)1 <br />Address* 3200 RBC 31 <br />Com.-ny: Natural Soda, Inc. <br />Rifle, Colorado 81650 <br />E-mail. simmse a :turalsoda.com <br />Tele .hone 970-878-3675 ext 13 <br />Name: Michael Clark <br />■ <br />■ <br />E-mail. clarkmenaturals4dacom <br />Com .•:n Natural Soda <br />Rand Dean <br />Tele. hone. 970-878-3675 ext. 25 <br />E-mail. rand .dean etaubandassociates.com <br />Com.: Daub and Associates <br />Name: Adam Chambers <br />Tele .hone. 970-254-1224 <br />E-mail. adam chambers0daubandassociates.com <br />Com.: . Daub and Associates <br />Name Jeff Paris <br />Te .hone: 970-254-1224 <br />E-mail: jell..: is • •ubandassociates.com <br />Com.. Daub and Associates <br />Tek .hone 970-254-1224 <br />Name. Helene Burklow <br />data will <br />NO <br />.L :.. <br />ARE UNFILTERED <br />E-mail: AccountsPa ab - NaturalSoda com <br />Com .: • Natural Soda, Inc. <br />Tele . hone: 970-878-3674 ext 22 <br />Ifsample(s) received past holding time (HT). or if insufficient HT remains to complete <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />If"NO" then ACZ will contact client for further instruction If neither "YES" nor "NO" <br />is mdicated, ACZ will proceed with the requested analyses, even if H 1 is expired, and <br />Quote il <br />Project/PO kc <br />Reporting state for compliance testing <br />Are any samples NRC licensable matenal? <br />.: i'! I; .Il ', ,! '... <br />i <br />ALL SAMPLES <br />YES <br />NO <br />be qualified <br />H I <br />,,0- <br />e 3 3 e <br />U C7 t:7 � <br />o 0 FA- ti.) V <br />. <br />x Z Z G0 a. <br />X <br />89-1 <br />3/10/2015 <br />12:00 <br />3 <br />X <br />---.-- <br />89-2 <br />3/10/2015 <br />14:25 <br />3 <br />X <br />------ <br />BG-5 <br />3/10/2015 <br />15:30 <br />3 <br />X <br />------ <br />DS-5 <br />3/10/2015 <br />15:55 <br />3 <br />X <br />-----. <br />2-C <br />3/10/2015 <br />16:00 <br />-©- <br />X <br />------ <br />DS-3 <br />3/10/2015 <br />16:45 <br />3 <br />XMI <br />-----. <br />.11111111111 <br />------------ <br />---------- <br />Matrix: SW (Surface Water) GW (Ground Water) WW (Waste Water) DW (Drinking Water) SL (Sludge) OL (011) Other (Specify) <br />! 'i1 AR6., <br />Please send back cooler. <br />Please send replacement bottle sets. <br />C24--c.,4;La 3n1n015 11:00 AM kPt---4 ,(7i/j <br />Inl_in.i! I .r. ail. <br />DAVID STEWART 3/11/2015 <br />og3 Cil <br />FRMAD050 09 04,01 <br />Daub & Associates, Inc. <br />Figure 4. Sample Chain of Custody Form. <br />Page B-7 Natural Soda LLC 2015 S A P <br />