Laserfiche WebLink
ADZ Laboratories, <br />2773 Downhill Drive Steamboat Springs, <br />Ftpor Cy <br />Inc. <br />CO 80487 (800) 334-5493 <br />t„i <br />C,Z%2 <br />Address: <br />30 <br />° iLI <br />0 <br />Art UUA, <br />Name: rNtS (ed hill CYNO <br />Company: C- AAA- rtsSoc,Sakes <br />Sa-Ae, <br />30o <br />E-mail: mcr1e\An-..1 P °Ulf C3tnn <br />Telephone: <br />'60-S 0180 051A 0 <br />E-mail:,CQ <br />S‘.ja,(' <br />‘ (6 @ (,COY <br />Name: 1 iStar\5 <br />Company: C,\(\4( fa& <br />Telephone: <br />303 qt. •c MO <br />Invoice to: <br />Name: Y -(\S l'ok" k" jW <br />HT remains <br />short <br />ACZ will <br />Address: <br />(� i o.S �1.o Ve�> <br />Company: Q4 RsAeteAaac- <br />C-b�,a, <br />E-mail: liM ; ,"6.,0 yj g NOtsQ l .car \ <br />Telephone: <br />If sample(s) received past holding tine (HT), or if insufficient <br />analysis before expiration, shall ACZ proceed with requested <br />N "NO" then ACZ will contact client for further Instruction N neither "YES" nor "NO" Is indicated, <br />to <br />HT analyses? <br />proceed with <br />complete <br />the requested <br />YES <br />NO <br />analyses, even If HT Is expired, and data will be qualified <br />Are samples for SDWA Compliance Monitoring? Yes <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />I�J <br />No <br />Sampler's Name: ''l <br />Sampler's Site Information <br />1 attest to <br />tampering <br />the authenticity <br />with the sample <br />State <br />W <br />Zip code <br />understand <br />and punishable <br />Time Zone <br />the <br />quote ur.r,ber) <br />time/date/location <br />• <br />or <br />i <br />*Sampler's Signatur - <br />and validity <br />In anyway, <br />us <br />m <br />3 <br />p <br />c.) <br />o <br /># <br />of this <br />is considered <br />ANALYSES <br />r <br />sample. I <br />fraud <br />REQUESTED <br />Cl' <br />that Intentionally <br />by State <br />(:rn.rch <br />mislabeling <br />Law. <br />lest or use <br />PROJECT INFORMATION <br />Quote #: %Q 34, <br />PO#: <br />Reporting state for compliance testing: <br />Check box if samples include NRC licensed material? <br />SAMPLE IDENTIFICATION <br />M -5- <br />DATE:TIME <br />4115 a. -21C) <br />Matrix <br />C,w <br />3 <br />-1s . <br />— <br />W -Eo <br />9 . x-10 <br />Mw - 2 <br />f U', O <br />MW - 1 <br />i Z'. 0Z_ <br />NM — 21 <br />1 Z'. yv <br />Mwl _01 <br />G'.y0 <br />M vJ - co <br />I U .. Zo <br />Mv4 --lr <br />ILI *Ay0 <br />V <br />Matrix. SW (Surface Water) • GW (Ground Water) <br />REMARKS <br />Please refer to ACZ's <br />RELINQUISHED BY• <br />rw. 1 LIow / <br />• WW (Waste Water) - DW <br />terms & conditions located <br />DATE:TIME <br />1 + l/9ll 1C/(o W <br />(Drinking <br />Wate <br />on the <br />RECEIVED <br />RECEIVED <br />) • SL (Sludge) • SO (Soil) • OL (Oil) <br />reverse side of this COC. <br />BY: <br />7' ___• <br />• Othe (Specify) <br />DATE:TIME <br />//-#'/ /4C <br />ADO50.0 'T4. <br />White - Return with sample. Yellow - Retain for your records. <br />