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ACZ Laboratories, Inc. (���� Ga • ' <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> NE.a <br /> Name: Sli Address h1 h B,vd 50 <br /> Company: p j4l�5 I 'a Kevjowr 90229 <br /> E-mail: y'�tV) d �� Telephone: &3 D <br /> 1 .. Report <br /> `/ <br /> Name: "V s-VI 1 w-y\ )0Vj E-mail: y-.(Y\\Y1C7 ,la o�d er.Cv✓►) <br /> Company: f� S j Telephone: 2 Q <br /> Invoice to: <br /> Name: Sam / 1/1 Address: <br /> Company: <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 if HT is expired,and data will be qualified <br /> Are samples for SDWA Compliance Monitoring? Yes No <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name:'SA Sa pler's Site Information State 0-0 Zip code Time Zone A:3E <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 <br /> -• INFORMATION <br /> - • REQUESTEO(attach list or use quote number) <br /> Quote#: Q 7611,9 <br /> t �a� V <br /> c <br /> Reporting state for compliance testing: a lrt <br /> Check box if samples include NRC licensed material? <br /> -1 lj!wf��4101'�y3 <br /> 1115-- bN1 3 x x <br /> Jv-3 8 b Ib I Z y G W 3 <br /> W1-} ie tb �00 G vi 3x X <br /> 10 <br /> Mill 49 iA& t350 60 3 x <br /> e ie I 15)0 1nJ 3 x <br /> mVj-1 lk 14 1325 6vi 3 x <br /> Matrix I SW Surface Water W Ground Water WW Waste Water DW(Drinking Water SL(Sludge) SO Soil OL Oil Other(Specify) <br /> REMARKS <br /> P <br /> �b c�o� Ce�1v� n CoaleS <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQLl . • . . • <br /> l � I� �6 llt7 <br /> FRMAD050.06.14.14 White-Return with sample. Yellow-Retain for your records. <br />