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AraZ <br /> Laboratories, Inc. L644 • <br /> 2773 Downhill Drive Steamboat Springs,CO 80487 (800)334-5493 <br /> Name: y: ru Address: <br /> Com --5 10;, C <br /> E-maN:i3r,C-f",40vl C' 2 X Telephone: <br /> Copy of Report <br /> Name _fie E-mail: <br /> Tele h ne: <br /> Name: Address: <br /> Co n <br /> E-mail: Telephone: <br /> If sam s received past holding me(HT),or if Insufficient HT remains to complete YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> !'W'a.n ACZ wM csdaa CIMM F.e.a.r W.-Id-.If-0.1-MV—'W I.rakM.a,ACZ A Ward.da a.r.a,r.rd r,Myw,...n H Hr i..apiad,and d ft re N.AeMerd <br /> Are samples for SDWA Compliance Monitoring? Yes L13J No <br /> if yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name: C�2-1.1_ Sampler's Site Information State CC? Zip code �1-iime Zone <br /> "Sam er'f S naWre: '+M+«era. Wft t kv".NAY 0nd<+Mnw.I nd—WW the Nr-d_ f�.A"s a.u.ardM./—ean e. <br /> pl ig rnaMend.ea <br /> PROJECT • e <br /> C <br /> Quote#: —)XLFCt <br /> t?#: <br /> C <br /> P _ <br /> Reporting state for compliance testing: u <br /> 0 t <br /> Check box if samples include NRC licensed material? ❑ 6 _ <br /> IDENTIFICATIONSAMPLE • •k <br /> s' - -6 sv✓ t [31 E31 ❑ ❑ ❑ ❑ 1 ❑ <br /> 1 D ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> cl ❑ D ❑ ❑ ❑ ❑ ❑ <br /> ❑ 01 ❑ ❑ ❑ ❑ D ❑ <br /> ❑ ❑ ❑ 131 ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ E31 D ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Me <br /> -o <br /> ❑ ❑ ❑ ❑ ❑ 0 ❑ D <br /> Matrix SW(Surface water)•GW(Ground water)•WW(Waste Water)'OW(Dorking Water)'SL(Sludge)•SO(Sol)•OL(Ol)•Other(Specify) <br /> c <br /> MM�r <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED • s <br /> to 1✓� S - c. Sa <br /> J k -�. . -•3 <br /> 2C <br /> 01 FRMAD050.06.14.14 White-Return with sample. Yellow-Retain for 96ur records. <br /> L64395-2103091 1 18 Page 9 of 9 <br />