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IAccredlted 2773 Downhill Drive <br /> Environmental Steamboat Springs,CO 8048�'// l �/� • <br /> Testing (970)879-6590 ,mil V <br /> LE-mail: <br /> e- 3Gc�� Address <br /> an : (� S: 1-ti fy -'7 <br /> tad1�.L.�.R cp..� Telephone: 0 X'ar $3a <br /> .. <br /> [Name: o S E-mail: tw+w s <br /> Company: Telephone: %i,,r `PPAcU' <br /> Invoice to- <br /> Name J s.w••-:. Address: Vo Ro <br /> Company: QS/+{'� CC, <br /> � �1 <br /> E-mail: Telephone: Q SrCopy of 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 ana"es? NO <br /> It'HW Um ACZ will d.w of o•rd for h.thw Mtl no ucti—II mWor"YES' r"MW 4 Ydabwill pwithld,ACZ will w do requ awi wWyw,—M HT■.apY.d,.rrd dm will b.quYYld <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: Sampler's Site Information State lA Zip cod,96X7 Time Zone <br /> 'Sam lets Signature: I~r w uw W"W*b*y w Vaddy a this.wnpa i"w ,w r. 'd Srt n"Nbebq tlw gnwdw.rw.e�wr <br /> P 9 e nv.r+w wth or.w..P..r,nyw.y.r..mid.rw rrrtl w.r pN•h•bl•by Ehe.Le- <br /> PROJECT •' • <br /> — Quote <br /> PO#: <br /> Reporting state for compliance testing: <br /> o <br /> Check box if samples include NRC licensed materials G <br /> e • rr• a; `M <br /> _ � v <br /> s2 aI- �b <br /> 7 �. <br /> 0 <br /> N <br /> 3 <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 /> C <br /> to <br /> —v <br /> iiiiiiiiiiiiiiiiiar- <br /> Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> REL!AQUISHED : DATE TIME <br /> b•5 t6 zL <br /> L73467akUQ_6154g%%8 Revision#• 2 White-Return with sample. Yellow-Retain for your records. age zoof 25 <br />