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ACZ Laboratories, Inc. G f..1_5)2V8 8 CHAIN of CUSTODY <br /> 2773 Downhill Drive Steamboat Springs,CO 80487 (800)334-549 <br /> Report to: c <br /> Name: it lb, :•Q ii/ a Address: + f�rA �A % 4 5 <br /> 0114)3 <br /> Company: ' KC, '• 115 141 611LA OJ d- .: %5o 2 <br /> E-mail:' '9L4c,1:}0 MM)O2A A pis,C A. Telephone:C7 3'4 ..03 a, <br /> Copy of Report to: �■ q <br /> Name: ldii 4 � E-maill1, e/A ,. i 4 I,r,C <br /> Company: A n CA 0 t's Telephone: (2L )-5t14)- cXO <br /> Invoice to: n h A <br /> Name: A cc o u rt PPPYAg Address: 7� ��✓�} • , 11 Sir 'p� <br /> Company: Aj1C4O�S 1416 - 4t' f,/�£ ?vv. <br /> E-mail: Telephone('�, )�� � '4 '. 5'-`P <br /> If sample(s)received past holding time(HT),or if insufficient HT remains to completeR lt C c tki YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? -i9 V?. 4b l..4,,ki NO <br /> If"NO"then ACZ will contact client for further instruction.If neither"YES"nor"NO"le indicated,ACZ will proceed with the requested analyses,even if HT�xpired,and date will be qualdd <br /> le <br /> Are samples for SDWA Compliance Monitoring? Yes I I No I <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. r <br /> Sampler's Name v� 11 Sampler's Site Information State Zip code '2- Time Zone M <br /> � ` 'I attest to the authenticity and validity of this sample I understand that mbntionally mislabeling the timeldatalloutlon or <br /> "Sampler's Signature: tempering with the sample in anyway,,s considered fraud and punishable by State law. <br /> PROJECT INFORMAL ION ANALYSES REQUESTED(attach list or use quote number) <br /> Quote#: l"-Ol-. 11% <br /> PO#: 62...c10, 2-Os cpL c ( �Q_ <br /> Reporting state for compliance testing: �;(JZ� c-/�,+ <br /> 7 - "" o <br /> U aCheck box if samples include NRC licensed material? C <br /> SAMPLE IDENTIFICATION DATE:TIME Matrix * °itE V. <br /> MW-7 44lL 1Z:. 0 W Li ` <br /> ,W <br /> M - i 2 ' ►j �e ll l ,5 i <br /> MY1N-1.3 y 14/ t-;3II GW <br /> "DU PLICA w/4'i IL cul q <br /> Matrix SW(Surface Water)•GW(Ground Water)•WW(Waste Water)•OW(Drinking Water)•SL(Sludge)•SO(Soil)•OL(Oil)•Other(Specify) <br /> xis ALL <br /> f..1 Fibmit.0.4 ort4 itt&TEAVA)-riVt <br /> -6" 'ihrE gy Ac <br /> 0 <br /> imie <br /> —tet• Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> 0 <br /> =c RELINQUISHED BY: DATE:TIME RECEIVED BY: DATE:TIME <br /> essuoimirmr MMIIIIIIII <br /> c � �/4 Ib I 11 r �� r r <br /> dd - <br /> L~f � 1� 1�4 White-Return with sample. Yellow-Retain for your records. Wage 13 of 14 <br /> I <br /> 1 <br />