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F <br /> DZ Laboratories, Inc. L H3d6ci • ' <br /> ' ownhi!!Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> -r Address: 1,Aza�TR- st�rr l�an A "1 L DS N" 1241 <br /> l'TCZtGK. 11M N P•AA�lS Tele hone: "77-0 ✓ � t <br /> ReportCopy of <br /> 4�ame U X E-mail: Rv CR rgAl)IS.6� <br /> : At y-1 Tele hone: 720 3N4-3�Amu NTS ploy Address: 30 L, SU VT E, 1jD <br /> Company: %1144LAt-V_5 NI Got 'au1 g-q <br /> E-mail: ITelephone: <br /> If sample(s)received past holding time(HT),or if insufficient HT remains to complete FI-64M CQNTACT YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? "lte,?_44 1404 H AP NO <br /> "NO"o—ACZ will s•dt•et•Hart ter tuM«Nshuobim.N nslth•r"Y■s-nor'NO"Is bWIwW,ACZ wl-I prs•sed w.h On npnst.d.nslys•s,won II HT Is•spr.A Md data will be aualNisd <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 /> Samplers Name: V `IZ Sampler's site Information State_Zip code)� -6 Time zone-MEWL <br /> •I.k•st to tM•Wb••ftky and wdldMy at ft.ssmpb. I undwsWW tiud lnt•nti•nsky mislfbNbq tie tlm.Idawllee•tlen« <br /> 'Sampler's Signature: t mpwWg wllh tiw ssmpW In s•ymy.s..nsld.r.d ftud oW t unisha is by at t.Law. <br /> PROJECT •- • <br /> RReporting <br /> 02U� <br /> e O icaD1 , (A <br /> for compliance testing:Cow lia V <br /> Check box if samples include NRC licensed material? c - 3 <br /> 'rW _ 3110116 e © GW X <br /> W- � o V30 Vi x <br /> MW - 3X16 1 tD.S` w4 Ix <br /> Matrix SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge)•SO(Soil)-OL(Oil)-Other(Specify) <br /> O <br /> N <br /> �. -vb N L_ 0'V AC L <br /> y j} <br /> T <br /> Please refer to ACZ's terms&conditions locatid on the reverse side of this COC. <br /> �hRELINQUISHED ■ . ■ ■ <br /> LP AQJ&®9�608.i$h431 White-Return with sample. Yell Retain for your records. i �;Page 13 of 14 <br />