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ACZ Laboratories, Inc. L �C�I� - CHAIN of CUSTODY <br /> 2773 Downhill Dme Steamboat Springs, CO 80487 (800)334-5493 <br /> Report <br /> e <br /> Name: e ��1+ Address: /l04 4 t Y1 tS_t <br /> Cons art Na', n I oZ <br /> E-mail: Telephone: <br /> Copy of Report to: <br /> Name: a,K/ J, Gt7ne E-mail: YV1dtf ck7a r-rn e <br /> Company: CU Telephone:aca SS cwz!5Su <br /> Invoice a 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 /> "NCr then ACZ will.ontact ollom terfurtber in■trueb..If ndth.r"YES"nor"NO"is indicated,ACZ will proosed with the"osted analyses,„'.n It MT is expired,10 dea will be awlFRsd <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: Samplers Site Information State G© Zip code.VV�4--t Time Zone MT^ <br /> "I athY to Uu aW lamldty and raaddy of this sample.1 understand that Intentionally nalslebMing the tlmaidswoostion or <br /> "Sampler's Slgnature. tempering whh the sample in <br /> anyway,is considered fraud and punishable try Stab Law. <br /> PROJECT •' • s <br /> Quote#: Z;ChvvchTF 71 wie m <br /> PO#: <br /> e <br /> Reporting state for compliance testing: p <br /> 0 �1 <br /> Check box if samples include NRC licensed material? c <br /> W�eeol � 19 IDtB Lb <br /> 0014 a•26•1y I oD Mri <br /> arsoorA U.2f- 161 I&OD WyVX <br /> a <br /> ,s <br /> e <br /> Wo <br /> dnx SW(Surface Water) GW(Ground Water) WW(Waste Water)-DW(Drinking Water) SL(Sludge) SO(Soil)•OL(Oil)•Other(Specify <br /> r <br /> �r <br /> �O <br /> --1L1 <br /> r <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHEDDA : ^ � � <br /> 1� 77_2L I Iro3 <br /> LINIMMO S 1417 White-Return with sample. Yellow-Retain for your records. Page 34 of 34 <br />