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IAccredited 2773 Downhill Drive <br /> Environmental Steamboat Springs,CO 804874RIii <br /> Testing (970)879-6590 <br /> Name: • <br /> +^� Address: <br /> Compan : re a <br /> SO <br /> ti.w E-mail: <br /> C AAAWIP, Jrvio, Telephone: <br /> Copy of Report <br /> Name: E-mail: <br /> Company: ITelephone: <br /> Haim <br /> F <br /> e: . .� Address: <br /> n -*o ail: f Telephone: <br /> i Copy of Invoice to <br /> Name: <br /> Address: <br /> Company: <br /> E-mail: Telephone: <br /> lit 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 analyses? NO <br /> ^la-12"Act we wrr.0 cent for hruw tn.trrctloe,it nrnw YES'nor HO t.ndtrabd,AM wta w.c..d wen trr�.v ed rmp.s.an if HT i..amMed.end date we to gwWad <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 Zip code Time Zone <br /> "Samplers Signature: ,aa..c a d.+vMOeft WO Mk tt,or ed.aa,mt..I Wd.iftw so n...e,,,r„mrre.rg m„r..,a,.,,,,�„a <br /> f+�w.ie w«n e»...p.ti+.r••a.r ooiridond baud aM omem.ea 4 9U..1aw. <br /> 'PROJECTORMATION <br /> Quote#: s000m <br /> PO#: c <br /> Re rting state for compliance testing: r <br /> 0 <br /> Check box If samples include NRC licensed material? <br /> 0 <br /> • e at <br /> t'�C iyD D <br /> I F_ I --- <br /> - I T_ 1 ]--1- <br /> 0 Matrix SW(Surface Water)- 1(Ground Water)-WW(Waste Water) OW(Drinking Water)-SL(Sludge) SO(Sod) OL(Oiq Other(Speciy) <br /> 7 REMARKS <br /> —may. <br /> O <br /> ,SC'C <br /> �O <br /> ilm <br /> Please refer to ACTs terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY DATE:TIME RECEIVED BY DATE�TIME <br /> on df <br /> M42M: <br /> of 12 <br /> 21 Revision#: 2 White-Return with sample. Yellow-Retain for your records_ <br />