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56� � -&- --1- (1-7 � <br />c- <br />0,11. <br />Laboratories, Inc. <br />• <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-54 3 <br />Name: Sue Webber <br />Address 2773 Downhill Drive <br />Company: ACZ Laboratories, Inc <br />Steamboat Springs, CO 80487 <br />E-mail: SUeW@acz.com <br />Telephone: 970-879-6590 Ext 110 <br />ReportCopy of <br />Name: I <br />JE -mail: <br />Company: <br />Invoice a <br />Telephone: <br />Name: <br />Address <br />Company: <br />E-mail: <br />Telephone: <br />If sample(s) received past holding time (HT), or If Insufficient H <br />remains to complete <br />YES <br />analysis before expiration, shall ACZ proceed with requested s <br />ort HT analyses? <br />NO <br />IM0'then AM nig—tad h -t for t.W rinstruction. 1tnahhar"YEB'rwr'It0'I61ndka1sd,AC <br />wig ptooerdwith the iegwsled anayses, gran It KT is osp40, erg data nig to qualified <br />Are samples for SDWA Compliance Monitoring? <br />Yes <br />No LM <br />If yes, please Include state forms. Results will be reported to PC L for Colorado. <br />Sampler's Name: Sampfers Site Information <br />State <br />Zip code <br />Time Zone <br />'!attest to lhsa entkltyandwedRYof this srmple.l understand thatlntentkatuly WsUberry the timerdats/loutbn or <br />'Samplers Signature: hmperk�wl6to sample Harswry,beonsWeredrrsvdendpurdshablebyStatslaw. <br />PROJECT INFORMATIONa <br />e(attach <br />Quote #: <br />PO#: <br />Reporting state to r compliance testing: <br />o <br />ty <br />Check box if samples Include NRC licensed material? <br />o <br />IAI <br />L24056-01 3:30 D <br />LS <br />S w `1t�53o1'� <br />L <br />% <br />13 <br />© <br />E ® <br />13.0 <br />® <br />11 <br />© ® <br />Elio <br />11 <br />01 <br />0 <br />® <br />© <br />1 0 <br />0 <br />El <br />01 a <br />1 <br />El <br />o <br />1 <br />01 <br />®n <br />] <br />Matrix SW (Surface VA let) • GW (Ground Water) • WW (Wasle Water) • DW (Drinking Water) • SL (Sludge) • SO (Soil) • OL (011) • Other(Spscify) <br />REMARKS <br />S1,6 (�P-```vco APR <br />0 W <br />rN <br />Please refer to ACZ's,terms t£ conciltionj <br />located on the reverse side of this COC. <br />RELINQUISHEDD. <br />IW tS i <br />- <br />FRMAD050.06,14.14 <br />L24056-1505201031 <br />White - Return vrith sample. <br />Y Ilow - Retain for o your records. <br />Page 14 of 14 <br />