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ACZ Laboratories, Inc. ����3CHAIN of CUSTODY <br /> 2773 Downhill Dave Steamboat Springs, CO 80487 (800)334-5493 <br /> Report to: <br /> Name: Address: <br /> Company: Ale G e��VOi1 <br /> E-mail: Telephone: <br /> Copy of Report to: <br /> Name: FnrL E-mail: jC1Lek 4fM <br /> Company: A I LC-7 Telephone: deaf-5-5 lGoSvl '� Gq <br /> Invoice 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 /> ■"NO"then ACZ will sentaai elied fw furthe indmaton.If wilher"YES"nor"NO"Is indicated,ACZ will prscaed with the raquastad analyses,scan tf NT Is espied,and dais will be gwlNiad <br /> Are samples for SDWA Compliance Monitoring? Yes I I No <br /> If yes,please Include state forms.Results will be reported to PQL for Colorado.Sampler's Name:/ &el/4 t/4c/Oifamplees Site Information State !C Zip code L� Time ZonwAn <br /> l atesst to the authenticity and validity of this sample.I understand that intentionally mislabaiinq the timeidstMloeailoe or <br /> *Sampler's Signature: famp.nnp vnlh fha sample In anyway,Is considered rrsud and puniahzbu by set.LAW. <br /> PROJECT • - +, • <br /> Quote#: <br /> to <br /> PO#: t = <br /> Reporting state for compliance testing: e v <br /> Check box if samples include NRC licensed material? o <br /> ■ e ■r ak <br /> .s Cam � w <br /> ......................... <br /> 0 <br /> �3a <br /> Matrix SW(Surface Water) GW(Ground Water) WVV(Waste Water) OW(Drinking Water) SL(Sludge) SO(Soil) OIL(Oil)•Other(Specify) <br /> �— <br /> Rw 1 zMARKS <br /> f� <br /> Please refer to ACEs terms 8f conditions located on the reverse side of this COC. <br /> RELINQUISHED ■r ■ ■ r <br /> 5 I1t02 <br /> L�t�Atp,BtUl2A►1fin9 White-Return with sample. Yellow-Retain for your records. Page 31 of 31 <br />