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ACZ Laboratories, Inc. L S2� �� • ' <br /> ' 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> •e. Me <br /> Name: LN(c1 ���.�1'��rl.�i Address: k�LA Uv ivc\ &\14 ' FEZ 3,00 <br /> Company Co Z�Z'�Z, <br /> E-mail: asc \�atktrt� c ��LcC,�c-r1 Telephone: 1G�'_c��p—C;�LA <br /> Copy of Report toi <br /> Name: \-A(.kN "CN cZ`nc.\c.^ E-mail: <br /> ' Company: _v\Z e: S Sor✓tlx•Et Tele hone: <br /> Invoice to: <br /> Name: ; Address: L1L\ \fin;. 3\��. SEC JCI7 <br /> ' Company: (��\�ti FfiJ�JC��``ty l�aticLw�vG� l� �ZZ <br /> E-mail: a tti \A af"cCk n� d 'L\,\e _C�/n Telephone: 5C� `t�C u <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 /> N"NO"then ACZ will aomoat ellem for further instmatlon.If neither"YES"nor"NO"is indluted,ACZ will prooead wkh the nq—stad analyses,wen if HT is expired,and data-11 be quN ed <br /> Are samples for SDWA Compliance Monitoring? Yes No I X <br /> ' If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name:M- L .\zl.\c,rt ampl s Site Information State (,: 1� a.�� Zip code 5-75 TimeZone\ASI- <br /> •I attest to the suthentieiry and validity of this sample. I understand that imenti—ally mislabeling the tlmeldatellooation or <br /> 'Sampler's.Signature: tamper ng with the sample in anyway,is aonsid.red fraud and punishable by State Law. <br /> PROJECT <br /> e• INFORMATION <br /> e • • e <br /> Quote#: "ULCIY A - `t'A\ 1 b0�12 3� `�- p <br /> m <br /> PQ#: 111Q1S`A9 rJ:��u`5 t���� nu�tir; <br /> ' Reporting state for compliance testing: p ? <br /> Check box if samples include NRC licensed material?SAMPLE ,�S <br /> IDENTIFICATION e • � <br /> i310 &V4 5 X <br /> � 11,o K 1S`1D LA 5 X <br /> Mva- 4 �IIz �G 11�i0 -w X <br /> N1.r.►-� � 1� �'t4 L�0 Lw 5 X <br /> v�1�1�,4"1�1 vtiy5 <br /> QPkall6kri 0,1w Gw <br /> Matrix SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil) Other(Specify) <br /> REMARKS <br /> G �G, CJ �t2\� � 1LStC ck_C-c'�\:� #t: hC� �,e_ 'r <br /> aS Nt r�o6-t?- 4 : Nc u6 <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> "m \�c�'t't�,cv; �:�,�tt>n �9 I� �y►i �� 772 r <br /> f I 12717 <br /> may, <br /> FOVA9%5`4969294443 White-Return with sample. Yellow-Retain for your records. Page 52 Of 55 <br />