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AW&= Laboratories, Inc. <br /> 2773 Downhill Drive SteamboatL So I�� • � <br /> Springs,COCd 80487 (800j 334- <br /> Name: <br /> Address: LA �r <br /> Compan <br /> -mail: <br /> lGm r Z i (L <br /> E a <br /> - C Telephone: ( a n4;• _ <br /> • <br /> Name: <br /> E-mail: u a <br /> Com an <br /> Tele hone: <br /> • o <br /> Name: <br /> Address: <br /> Company: <br /> E-mail: <br /> Telephone: <br /> Hsample(s)received past holdingtime H <br /> ( T),or if Insufficlent HT remains to complete YES <br /> EA <br /> e expiration,shall All proceed with requested short HT analyses? <br /> onyot, M"Ierr,, w inetfydon.M naM,er"Yi8"net"NO"ie Indleated,ACZ will roe•ed with IM rsquubd aoeyeea,ewn tl HT k• i NO r SDWA Compliance Monitoring? p ap"d end die wn11 be gnaOfMd <br /> Yes <br /> nclude state forms.Results will be reported to PQL for Colorado. No <br /> Samplers Name: V Sam e s Site Information Stat (� <br /> 'Sampler's Signature: �e, +ea..,,,,,�1Ue Zip code Time Zone {� <br /> nY and validiy of this sample.I understand that Intentonapy mlelabeYny the t0neld■benceetlon er <br /> tompeft with the 6411 In snywwy,Is 9e061111 fraud and punishable by State Law. <br /> QUntB#: <br /> Pd#: m <br /> WPM <br /> G �A <br /> Reportin state for Compliance testing: ) <br /> Check box if samples inQPT_ clude NRC licensed material? V y <br /> r~ <br /> 0 <br /> i 84, <br /> ­v <br /> �.0 <br /> M tII tnx SW(Surface Water) GW(Ground Water)•WW(Waste Water) DW(Dnnking Water) SL(Sludge)MOOtherOIL <br /> --� <br /> �� <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> 777P7Yellow <br /> Lo �)ayL501$g5191431P509 white-Return with samplen7�,. records. 1 <br />