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ACZ Laboratories, IncZV-/ 2 ,7� <br /> • <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334`5493� <br /> Name: ri i v� Address: 4 A10lt1 S ��Cl. S01,4- Sod <br /> Company: e� 5 tO�.�G L �-0 $0 ZZ <br /> E-mail: kM1nC Otag •Gp'M Telephone: p•3 <br /> Copy of Reporl <br /> Name OTC �CI $ E-mail: i(1 e.i CAS <br /> ' Company: CnakAo r Telephone: <br /> Invoice to: <br /> Name: rk ` F' Address: (SCt wbou�� <br /> ' Company- C S4-4L v <br /> E-mail: Telephone <br /> ' If sample(s)received past holding time(HT); or if insufficient HT remains to complete YES <br /> an alysis 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"Pi is mdleated ACZ will proceed with the requested analyses,eVP r.f HT is expired and data will be quahfled <br /> Are samples for SDWA Compliance Monitoring? Yes No 1 <br /> If yes, please include state forms. Results will be reported to PQL for Colorado. <br /> Sampler's Name: Sampler's Site Information State CO Zip code Time Zone__�� <br /> 'I attest to the authenticity and validity of in,,sample. I understand that intentionally u.I.t I.n9 the hmaidalelldc.tion o• <br /> .Samplers Signature: tampering with the sample in anyway.is considered fraud and punishable by State Law. <br /> SES <br /> '• • ''�•-• REQUESTED <br /> (attach list or use quote number) <br /> Quote# �j 5J UL1_1 Q wok <br /> -q m <br /> PO# `5 T� <br /> Reporting state for compliance testing: co � <br /> o <br /> U It <br /> Check box if samples include NRC licensed material? o t <br /> 1041 C2W x <br /> W -Z Slitx <br /> 1fJ -"S l !(4 11 U <br /> 1 1 <br /> 1fJ -S 613lifflU 0 0 <br /> 1300 x <br /> Pal I Lt. 125410X <br /> ' MW - IS slit I -6 01`<S <br /> w -ZG 31 11(• — x <br /> 0 <br /> N Matni, SW Surface Water GW(Ground Water` WW Waste Water OW(Drinking Water) SL(Slug e; SO Soil) OL;Oh Other(Specify) <br /> ( ) � ( ) 9 9 1 ) <br /> REMARKS <br /> C <br /> Please refer to ACZ's terms& conditions located on the reverse side of this COC. <br /> RELINQUISHED BY: DATE:TIME RECEIVED BY: DATE:TIME <br /> D o 711474 White-Return with sample. Yellow-Retain for your records. D <br />