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ACZ Laboratories, Inc. L Soco6Co • ' <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> Name: EC' I4 90"MAL) Address: R, SIA"b POO <br /> Company: ARCA i N lG N L/A�45 C)=,- 13 c3 1'7 <br /> E-mail: w 8oAmAP Q AR CAD)5,C-,-->AA Tele hone: 22 ,q <br /> Copy <br /> Name: u EA E-mail: .��jA�G 2Z S,LbM <br /> ' Company: R Ga l ITelephonetZ2 6 7 5 DID <br /> Invoice to: <br /> Name: A�.O 1�S'`� Address: P LQ DiK• 5U t I t PO <br /> ' Company: 6 W> RAPCH., CO. 4343 )-2- <br /> E-mail: Telephone: <br /> ' If sample(s)received past holding time(HT),or if insufficient HT remains to complete Pt,jA- s4 C,0NVtCT YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? -r.Qxc)< H45PM A P NO <br /> If"NO"than ACZ will contact client for further instruction. If neither"YES"nor"NO"Is indicated,ACZ will proceed wnh the requested analyses,even if FIT' ea Ind,and data will be quat d <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 /> Sampler's Name: UD` Sampler's Site Information State CO Zip codesfy1 Time Zone <br /> 42 '1 attest to the authenticity and validity of this sample.I understand that intentionally mislsbelin9 the tlmeldate/location or <br /> eSampl@r's Signature: tampon with dw ample in anyway,is considered fraud and punishable by State Law. <br /> PROJECT •• pp e <br /> (attach list or use quote number) <br /> Quote#: 01-(,1 im ("^ t <br /> PO#: boo 2 5,!�10 ) L. c <br /> Reporting state for compliance testing: Co LO b 0 <br /> U <br /> Check box if samples include NRC licensed material? 1 `o Z 3 <br /> • e • a • 3t <br /> M - 3 Za ! X <br /> - 1,9 1i }3� COO <br /> w <br /> IMP LI(ATE. 311di) <br /> ----------------- <br /> ' Matrix SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil Other(Specify) <br /> At_( , AYD PAE,5i-�-KVA,T1Vii-S <br /> To <br /> mz— <br /> ' O <br /> � Please refer to ACZ's terms&conditions located on the reverse side of this COG. <br /> RELINQUISHED BY DATE:TIME RECEIVED BY: DATE:TIMF <br /> 'Ica <br /> --in <br /> ' l (2WW14117 White-Return with sample. Yellow-Retain for your records. Page 13 of 14 <br />