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AC 9-(0--- <br /> Z Laboratories, Inc. L50 f • <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)XW-5493 <br /> ee <br /> Name: Address: (/ <br /> Com an !2-1 <br /> E-mail: r Telephone: <br /> Copy of Report to: <br /> Name: J/YtZQj E-mail: I eS <br /> Compare Tele hone: t^Lr�hll� C.'ct,,, <br /> Invoice ,Name: <br /> Address: <br /> Company: <br /> E-mail: Telephone: <br /> If sample(s)received past holding time(HT),or if insufficient HT remains to complete E <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> If"NO"then ACZ will contest client for farihor Inslwatlon.If neither"YES"nor"NO"Is Indiwhnl,ACZ unit proceed with the regwsled analyses,even if HT m expired,and dale will be gwlill 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: Sampler's Site Information State 6C2 Zip code Time Zone <br /> •Sam Ier'8 Sign,nature "I albst to the n thenhedy and validity of this sample I und.r:t.nd th.t tnt.naenalty misleMlin■the tlmemawic Lion or <br /> P 9 t■mWng wdith the sample In any—y,Is considered fraud and punishable by Stato Law. <br /> PROJECT INFORMATION <br /> Quote#: �► <br /> Reporting state for compliance testing: c 0L161 <br /> Check box if samples include NRC licensed material? c � <br /> ■ • 77 <br /> a C/J <br /> `7 or! ► <br /> a <br /> N <br /> --s <br /> �! <br /> -'a Platrix SW(Surface Water) GW(Ground Water)•WW(Waste Water)•DW(Drinking Water) SL(Sludge)-SO(Soil) OL Other(Speafy) <br /> C <br /> aaaaaal�erf <br /> aaaa� <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY: ■A ■ ■ • <br /> r�24_9"S" <br /> r Q � 2 M <br /> ��1419 White-Return with sample. Yellow-Retain for your records. 1 <br />