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A Z Laboratories, inc./ 2- 97 9 CHAIN of CUSTODY <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> Report to: <br /> Name: ri4IPt.a. �I��Y\[, eO Address: 9L4 Ur a P ttif . <br /> Company: 1de r /^p� ats� ;c��4tS I _okko_AA ek , CO Boz <br /> E-mail: t(,.Minckni.0 . • •.Blair . CO M Telephone: .p 2 — 9 - cog"-lt0 <br /> Copy of Report to: ` C <br /> Name: o rte,. che .,\rS E-mail: �Y�,Q,,r,L:vr' S e, z„\re.r• co <br /> Company: CALM ttr Telephone: 3a�, -1 SO e0,5 410 <br /> Invoice to: <br /> Name: 5.„,,,,, A,.,;r.5 Address: <br /> Company: 5,1",-"-.A 10. 4000144, <br /> E-mail: Telephone: <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 /> If"NO”then ACZ will contact client for further instruction. If neither"YES"nor"NO"is indicated,ACZ will proceed with the requested analyses,even 0 HT is expired,and data will be qualified <br /> Are samples for SDWA Compliance Monitoring? Yes No f <br /> If yes, please include state forms. Results will be reported to PQL for Colorado. <br /> Sampler's Name: V,If4tM Sampler's Site Information State CO Zip code Time Zone MS`'r <br /> 'I attest to the authenticity and validity 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 INFORMATION ANALYSES REQUESTED(attach st or use quote otvnber) <br /> Quote#: O ','4 t 3O to <br /> t- <br /> at <br /> PO#: IS 4 (o -+S `- <br /> c 1c� <br /> • <br /> U C� -1e, 3" � <br /> Reporting state for compliance testing: CO o `e <br /> r �® <br /> Check box if samples include NRC licensed material? o e0 l�& <br /> SAMPLE IDENTIFICATION DATE:TIME Matrix u <br /> te‘Vi z-IS-14. 11:6{< Cs+w 3 <br /> Mw -7..._ 1i....i<s 3 <br /> MW -S to:`A 3 <br /> P1bd -4 °I'.A5 3 <br /> r vi -S 9: 15 t - <br /> MW - Ca 1i:14" 3 <br /> P}i W --4 13:95 3 <br /> MOn4 - <br /> 1C 8:aa 3 <br /> tM tii -1.0 v 10 o o S <br /> Matrix SW(Surface Water)•GW(Ground Water)•WW(Waste Water) DW(Drinking Water)•SL(Sludge)•SO(Soil)•OL(Oil)•Other(Specify) <br /> REMARKS <br /> Z' <br /> 0 <br /> it <br /> -7 <br /> =U <br /> —-c Please refer to ACZ's terms &conditions located on the reverse side of this COC. <br /> r--ti RELINQUISHED BY: DATE:TIME RECEIVED BY: DATE:TIME <br /> Kehr '„a Piil oul si 2./lc lk 3:0e tc%/ u7 /77- <br /> G�� f C = c <br /> = / 6 ie <br /> ---`(_2WtA94.o.3g4 White-Return with sample. Yellow-Retain for your records. Page 21 of 21 <br />