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ACD... Laboratories, Inc. 5d2773 Downhil Steamboat Springs, CO 80487 (800)334-5493 <br /> Name: 1vIP7-vb Address: /Al--?L Hal/ ? <br /> Company: AUX 60 CA YvP1 C. <br /> E-mail: /1'Jbe <br /> 4&q1eX69 I"L..7(Je�[KIP• Telephone: <br /> Copy of Report to: <br /> Name: Q l7 e E-mail: V'/L7e <br /> Company: Tele hone: <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 /> It"No"Men ACZ wMl"need client for further Instruction.If neither"YES"nor"NW In Indkated,ACZ MR proceed with the requested snalyses,even N HT Is expired,and date will be gwlSled <br /> Are samples for SDWA Compliance Monitoring? YesL_j No <br /> If yes,please include state forms.Results will be reported to POL for Colorado. <br /> Sampler's Name:/�- z. Samplers Site Information State GO Zip code Time Zone 1? r— <br /> /'/J .1 acted 10 the euthenticily end validity of this sample.I understood Met lntentlonally mislebding the 1bse/dNNloeetlen or <br /> "Samplers Signature: ! limped rMM the sample In anyway.Is considered feud and punishable by Slots Law. <br /> PROJECTINFORMATION <br /> Quote#: G WQ Y R k- /�'(� 1 I� <br /> PO#: c <br /> Reporting state for compliance testing: c <br /> Check box if samples include NRC licensed material? c l <br /> e • e � � vl <br /> Matnx SW(Surface Water)-GW(Ground Water)•WIN(Waste Water)•DW(Drinking Water)•SL(Sludge) SO(Soil)-OL(Oil)-Other(Specify) <br /> Z7 <br /> a <br /> 3 <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHFID BY. eA eA <br /> �t <br /> 2 10,Lo <br /> —m <br /> --rn <br /> L2$ �d4E58 White-Return with sample. Yellow-Retain for your records Page 33 Of 33 <br />