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ACZ Laboratories, Inc. LM21 A <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> •. <br /> Y <br /> Name: Address: 1 �Jlirt:. <br /> Company: AACA D P3 H16HLA,000 cb� b i2-l' <br /> i <br /> E-mail. C.�, G (MCA �,;C '�1 Telephone t bO I <br /> 1 <br /> . . <br /> ' ��p I 1 <br /> Name: vtt�E E-mail: <br /> Company: Q L� Tele hone: zz <br /> Invoice to: <br /> LIE Address] n Uj <br /> Company: U 1, W P &j I �olza <br /> E-mail: Telephone 7tb <br /> If sample(s)received past holding time(HT),or if insufficient HT remains to complete fti '': 5, CTYES <br /> �� C�� <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? T�� H.6h ,,4 J NO <br /> [il_ <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 it HT is es Ired,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 /> Z <br /> Sampler's Name: 1JY � <br /> Sampler's Site Information State Ws� I Zip code�l Time Zone _ <br /> •I attest to the authenticity and validity of this sample.I understand that intentionally mislabeling the time/dataflocation or <br /> *Sampler's Signature: tampering with the sample In anyway,is considered fraud and punishable by State Law. <br /> PROJECT • ' ANALYSES REQUESTED(attach list or use quote number) <br /> Quote#: In <br /> PO#:'�cX�2 I o. ) <�%x <br /> a t <br /> w � <br /> Reporting state for compliance testing: p a <br /> Check box if samples include NRC licensed material? o <br /> W—`� �� ( � •, l,r oaf W <br /> N - i 1 :r X <br /> PU "1 1 w 1 <br /> i <br /> I <br /> N <br /> _�_ <br /> Matrix SW(Surfare Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil) Other(Specify) <br /> kEMARKS <br /> __4f <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHEDD• ■ . <br /> 317117 177 1KA13 I Hz� <br /> L3W °hL'�lbbt8 White-Return with sample. Yellow-Retain for your records. Page 13 of 14 <br /> i <br />