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A'CZ <br /> Laboratories, Inc. , <br /> 2773 Downhill Drive Steamboat Springs, CO 80487 (800)334-5493 <br /> a a <br /> Name: pakfq Address: <br /> Compan . > s <br /> E-mail N ' Telephone: <br /> Copy of Report <br /> Name(f r� E-mail: <br /> C o m p an Telephone: <br /> Invoice to: <br /> Name:�f Address: <br /> Company <br /> E-mail: c7-- Telephone: <br /> If same e(s)received past h Iding time(HT),or if insufficient HT remains to complete YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> If"NO"then ACZ will contact client for further instruction.If neither"YES"nor"NO"is indicated,ACZ will proceed wfth the requested analyses,even if HT is expire rid data will be qualified <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 Name. N Samplers Site Information State Zip code Time Zone m <br /> '1 attest to the-Ownt city and validity of this sample. I understand Met intentionallymislobeling the bmNdateAoeacen or <br /> 'Sampler's Signature: tampennp with IM•ample in anyway,is conalderM Mud and punishable by Stab Law. <br /> PROJECT •R • a <br /> Quote#:s <br /> m <br /> PO#: <br /> Reporting state for compliance <br /> testing-0 C <br /> Check box if samples include NRC licensed material? c t� <br /> . • .• sk 111"��� `aAA <br /> 15 e /'. v• <br /> Matd. SW(Surface Water) GW(Ground Water) WW(Waste Water) DIN(Drinking Water) SL(Sludge) SO(Soil) OL(Oil) Other(Specify) <br /> REMARKS <br /> 4 . <br /> 0 <br /> .j <br /> N <br /> 3 <br /> ——'0 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 /> ro ri 5IL6 C4.P5 24LS - Ir <br /> OEM� <br /> _v <br /> FRMAD050.06.14.14 White-Return with sample. Yellow-Retain for your records. Page 1 O 15 <br /> L64296-21UZ241528 <br />