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Laboratories Inc. ' <br /> ACZ <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> Name: t IAcilA Address: yy <br /> Company: , er t <br /> E-mail: W hC, Telephone: T:iliI —9I — 7q0 <br /> Copy of Report <br /> Name: c3dLr-6. q,lr`e%V%5 E-mail: <br /> Company: ve, Telephone: S ovv%.,y <br /> Invoice to: <br /> Name: 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 /> H"NO"then ACZ soil contact clam for further Instruction If nelther"YES"nor"NO"is Indicated,ACZ vviii proceed Mitt the requested analyses,even If HT is expired,and data will be qualifietl <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 /> Sampler's Name: Sampler's Site Information State Co Zip code Time Zone�T <br /> •I ttest to the authenticity and validity of this sample I understand that intentionally mislabeling the timeldatallocation or <br /> 'Sampler's Signature: tampering with the sample in anyway,is considered fraud and punishable by State Levi. <br /> PROJECT INFORMATION REQUESTED ' <br /> Quote <br /> PO#: <br /> ZASZ <br /> to .ip <br /> Reporting state for compliance testing $1111111— c ` <br /> Check box if samples include NRC licensed material? c <br /> 41 <br /> r— S77 <br /> at►M <br /> JKW -1 <br /> ° Matrix SW(Surface Water)-GW(Ground Water)•WW(Waste Water) DW(Drinking Water)-SL(Sludge) SO(Soil) OL(Oil) Other(Specify) ' <br /> �C <br /> W.- <br /> �M ' ( <br /> See <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. ' <br /> RELINQUISHED • • • • • <br /> L�3� 21�42 White-Return with sample. Yellow-Retain for your records. Page 22 of 23 , <br />