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ACZ Laboratories, Inc. L(aJ • <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> Name:Vrfanc' Address: <br /> Company: Jti - Se <br /> E-mail: r"c� , gJ�c,, s C Telephone: <br /> Copy of Reportto: <br /> Name: y-i E-mail: <br /> Company: ]Telephone: <br /> Invoice a Name: Address: <br /> Company:aG y-ei a <br /> E-mail: n C. , C'0 Telephone: <br /> If sample(s)received past holding(ime(HT),or if insufficient HT remains to complete YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> It"NO"then ACZ will contact client for(unbar instruction.If neither"YES"nor"NO"is indicated,ACZ will proceed with the requested analyses,even if HT is expired,and data will De qualified <br /> Are samples for SDWA Compliance Monitoring? Yes No <br /> If yes,please include state forms.Results will be reported to POL for Colorado. <br /> Sampler's Name: y Sampler's Site Information State C.,n Zip code Time Zone <br /> -1 attest to the authenmity and validity of this sample.1 understand that intentionally mislabeling the timeldatNlocatlon or <br /> 'Sampler's Signature: urns ering with the sample in anyway,Is considered fraud and punishable by State Law. <br /> PROJECT • •N ANALYSES REQUESTED <br /> Quote#:0f <br /> d <br /> PO#: <br /> Reporting state for compliance testing: c <br /> rJ <br /> Check box if samples include NRC licensed material? c <br /> All e • e • <br /> 5W3 <br /> a <br /> 0 <br /> Matrix SW(Surface Water) GW(Ground Water) WW(Waste Water) DW(Drinking Water) SL(Sludge) SO(Soil) OL(Oil) Other(Specify) <br /> O <br /> —— t Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHEDD• D• <br /> r,5 4-0o G <br /> ) , <br /> L6FRM 0 8�f 1 14 White-Return with sample. Yellow-Retain for your r rds. Page 37 of 37 <br />