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ACZ Laboratories, Inc. �, C� ( CHAIN of CUSTODY <br /> 2773 Downhiq Drive Sfeamboat Springs,CO 80487 (800J 334-5493 <br /> Report <br /> Name: hum (�' Address: t�a� glVl <br /> Company: X[nD H� C v <br /> E-mail: Telephone: <br /> ReportCopy of <br /> Name: G1 h ,D6(C Yj/h E-mail: �Gt G (�'Y►'J't Q @ a CC PSS <br /> Compan Tele hone: lfz /w klL l✓� C� <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 L113 <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> WNW then AM will contest ellont for fuller Instruction.if neither"YE8'nor"NO"la Indicated,ACZ wwll premed with Ill requested anstyms.Avon If HT Is expired,And data will be qualKnd <br /> Are samples for SDWA Compliance Monitoring? YesLLJ No <br /> If yes,please Include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name: Sam Isr's Site Information State Co Zip code Time Zone <br /> 'Sampler's Signature' Z S� .t ate o with u ueady and validLLy of this umpte.t understand tit!intentionally rehlebellny the trmehtarefbosEcn o <br /> tam rin rr*ie In anyway,is considered fraud and punishable by Stale Law. <br /> PROJECT INFORMATION ANALYSES REQUESTED ottoch bst u—q­r� <br /> Quote#: G (.c xcxc <br /> m <br /> PO#: c Q� <br /> Reporting state for compliance testing: o <br /> Check box if samples include NRC licensed material? o <br /> MIN1141111101 I gilimulwiliLeig • • 46 tQ <br /> 06 2 b Iqjq 4L,%) 10 x <br /> Q <br /> ,N <br /> 0 <br /> IM L Matrix SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water)-SL(Sludge)•SO(Soil)-OL(Oil)•Other(Specify) <br /> WFn <br /> fir► <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY. D• •• <br /> l9 �� <br /> WXM&Ie9d).0&2 A416 White-Return with sample. Yellow-Retain for your records. aQe O 1 <br />