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ACZ Laboratories, Inc.��;' j(p • <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (600)334-5493 <br /> Name: • / rkf Address: <br /> Com an . <br /> E-mail n,c4 ' Telephone: <br /> ReportCopy of <br /> Namec h E-mail: A <br /> Companyaf= Tele hone: <br /> Invoice to: <br /> Name:'¢l �lt,4-- ' Address: <br /> Com an <br /> E-mail: 3.cis. Telephone: <br /> If samplelI received past h Iding time(HT),or if insufficient HT remains to complete YES <br /> t!T <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> If"NO"then ACZ will eordaet eli.rd for fudhor instruction.N norther-YE8"nor"NO"is indicabd,ACZ will proeesA with the rogrststod snalyses,oven N HT is espf nd den will b.qualihod <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 Namec'),rl- Samplers Site Information State lZ2 Zip code �me Zone �t <br /> '1 odes to th.-,.dy snd validity of this sample. I und.rsnnd thN i aly mleleMliny the timMdatMooation or <br /> 'Samplers Signature: tompenn0 with the sample in anyway,le eonsidored Mud and punishable by 8tato taw. <br /> PROJECT •R • <br /> Quote <br /> m <br /> PO#: <br /> Reporting state for compliance testing: <br /> 0 LU <br /> Check box if samples include NRC licensed material? i- <br /> • • e • at � <br /> w Is '• S' . 'W <br /> Matnx SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil) Other(Specify) <br /> REMARKS <br /> O <br /> N <br /> 3 <br /> _-"o Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY: DATE:TIME RECEIVED BY: DATE:TIME <br /> rs C4PS 3 S <br /> FRMAD050.06.14.14 White-Return with sample- Yellow-Retain for your records. Page 15 Ot 15 <br /> L64296-2102241528 <br />