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ACZ Laboratories, Inc. L 501q� R <br /> 2773 Downhill Drive Steamboat Springs, CO 80467 (800)334-5493 <br /> N Address: lb� PiRame: <br /> Company: aklan <br /> E-mail: (�fh 1� rt Telephone: <br /> Copy of Report <br /> Hme: YYYIQ� E-mail: <br /> ' QS COh 47 .(4 Tele hone: <br /> Invoice to: <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 <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> "NO•tbm ACZ wile oonMd cUent forfunher imtruotim.If nahher"YES'nor"NO"Is Indlealod,ACZ w0 proseed with tha requustod analyses,won n HT Is expired,and data will he gualiGed <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 /> Samplers Name: +YYt Sampler's Site Information state C Q Zip code Time Zone M <br /> •I attest to the aWhentlally and val Why of this sample.I understand Mat inlsMlonaly ndslabeWn0 the timaldslalboation or <br /> *Samplers Signature: WAWtompedny with the sample In anyway,is oonsWered fraud and punishable by tide Law <br /> PROJECT •• • REQUESTED <br /> Quote#: <br /> PO#: <br /> Re rti state for compliance testing: p <br /> V <br /> Check box if samples include NRC licensed material? c <br /> 9 • • • lk i <br /> :5N �- — QZ'26•19 2� S 10 <br /> sw-W115 1IZ. 1211 Sid ►D <br /> Matrix SW(Surface Water) GW(Ground Water)•WW(Waste Water)-DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil)•Other(Specifyj� <br /> REMARKS <br /> .6 <br /> 0 <br /> v <br /> �3 <br /> 0 <br /> a Please refer to ACTS terms&conditions located on the reverse side of this COG. <br /> sac , RELINQUISHED • • a e • <br /> ■�■aaa�.y <br /> �C <br /> =MO6 <br /> ila4DO90023:1447 White-Return with sample Yellow-Retain for your records. Page 35 of 35 <br />