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i <br /> ACZ Laboratories, Inc (7/7;_,72CHAIN of CUSTODY <br /> 2773 Downhill Drive Steamboat Springs, CO <br /> 80487 (800)33 - 493 <br /> Report to: `` <br /> Name: Kr;'S\�..o. MihLho,IJ Address: LIy 0,N:,,,. ('S1 ,J . ` ,,t10 ZOO <br /> Company: _Clojatc Assoc'tt:.><S 3 I-,lta,...,:.,,.‘., ;A ?h 97 9i <br /> E-mail: 4 ,t-c l'.L t,,, e oej tee r . ct.torn Telephone: SO'I C1$3 °-i t) <br /> Copy of Report to: <br /> Name: Sc.„--)._ \-kr,r E-mail:V.,tY.s *-;.VN .. A,Iv s ' 16( a . C.6"— <br /> Company: Cie\ac c Telephone: <br /> I <br /> Invoice to: <br /> Name: 5L;,,,,...t_ ws .2,bc rz Address: <br /> Company: C1.0(h e <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.H neither"YES"nor"NO"is indicated,ACZ will proceed with the requested analyses,even If HT Is lupi •,and data will be qualified <br /> Are samples for SDWA Compliance Monitoring? Yes I I No I I1 <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name: P Jt /i k C Sampler's Site Information State CO Zip code 1 Time Zone (QST <br /> e - "I attest to the authenticity and validity of this sample. I understand that Into •nally mislabeling the time/date/location or <br /> Sampler's Signature: tampering with the sample In anyway,Is considered fraud and punishable by tate Law. <br /> PROJECT INFORMATION ANALYSES REQUESTED(attach rat sr use quote number) <br /> Quote#: 1ti' 0LCLM - C1 to <br /> su <br /> PO#: Ill- Z`13 <br /> 03 <br /> Reporting state for compliance testing. CO c See, UO rZ <br /> Check box if samples include NRC licensed material? w ( �, No CVA C <br /> T NO <br /> SAMPLE IDENTIFICATION DATE:TIME Matrix ale <br /> jOkV4- i II(ISlt - 09! 6cQ. Cj 3 <br /> MW t1-l5-1i- iv>tiy (a V.) 3 <br /> V1/4/‘vs) -.71 It-\S-Ile 1G c,) Civ.) 3 <br /> M W -tk 11 - 1C-II 115- t t_-tw 5 <br /> M\id - S. 1i-IS -1A .‘7-4c CI 3 <br /> MW - (2 ii-tS -IA 015-0 tiuJ 3 <br /> MW - -4- Il-ti - th I ;2J (-IVi <br /> M'4 - !S II-1 -1. — C,W <br /> YAW - Z11;,) 11 -1`i-P- -- (� W <br /> 1 <br /> Matrix SW(Surface Water)•GW(Ground Water)•WW(Waste Water)•DW(Drinking Water)•SL(Sludge) SO(Soil -OL(Oil).Other(Specify) <br /> t REMARKS <br /> o <br /> .s <br /> to <br /> 3 <br /> V <br /> r <br /> C <br /> Ia.; <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 /> 0 00Q tIfiCiti Ittm Get' /(,, -- ,/7 . /7- 2 7 <br /> l L.-•-- i�j, /7 Z sig' l' if/ i7 /oul <br /> L4IftVg915PIDIT110.1347 White-Return with sample. Yellow-Retain for your records. Page 23 of 25 <br />