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L77CZ Laboratories, Inc. <br /> 3 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> Name: ep,,i� tis Address: 6-or 5v <br /> Company: 0 2 29 <br /> I <br /> E-mail: b YY) Telephone: 3Q <br /> Copy of Reportto: <br /> Name: 1-,r �111 1►�� 0W E-mail: ( lln a Ot! P; io✓� <br /> m a' Con ew S I Telephone: 3 Q osqo <br /> e Name: V 1/) Address: <br /> Company: <br /> E-mail: Telephone: <br /> 1 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 /> P�] <br /> N"NO"than ACZ will contact client for further Instruction.if neither-YES"nor"NO"Is indicated,ACZ will proceed with the requested analyses,even H HT is expired,and data will be qu■Ilfled <br /> Are samples for SDWA Compliance Monitoring? Yes I I No <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Samplers Name:90r 4A Sa piers Site Information State C'Q Zip code Time ZoneAA:R: <br /> •1 attest to the authenticity and validity of this sample.I understand that Intentionally mislabeling the timeldatelloc■tlon or <br /> 'Sampler's Signature: tampering with the sample in anyway,is considered fraud and punishable by State Law. <br /> PROJECT • a • e ■ <br /> Quote#: 0 355 1h <br /> ' PO#: <br /> Reporting state for compliance testing: c a (vet _ <br /> Check box if samples include NRC licensed material? c � ` T� <br /> 714�V ,5 <br /> xV zzill G VV 3 <br /> w tb I(o s u) 6 111 3 X YX <br /> flu 40 10 ib t3,50 6 VJ3 x <br /> a , , 15►o N1 3 x <br /> I MU)_1 13Z 5 6vi <br /> 3 <br /> 0 <br /> ZZ,a 3 <br /> 1 tp Matrix SW(Surface Water) W Ground Water) WW(Waste Water)-DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil)•Other E(SP-t- ) <br /> REMARKS <br /> Samp Ps Fi�,(d ►NeYe� <br /> I ��b c�o� Ce�v�n Co a1CS �lE <br /> ' Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUiSHEDD• D <br /> Ll <br /> L ff­__ <br /> FRMAD050.R 14.14 White-Return with sample. Yellow-Retain for your records. <br />