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Laboratories, Inc. <br />2773 DuwntuV Drive Steamboat SprLrgs, CO 80487 (8!101 334-54 83 / <br />L. ` ' <br />~ ~ <br />Name: R7" SID R!$ Address: <br />Can an: [p,tlu7ELL R~SDURtg, <br />E-mail: (,~y4O/Ty co~al~Ja-l~rcSeuZcy. Tel one: <br />Name: E•ma0: <br />Cana Telephone: <br />Name: Addresa- <br />Campany: <br />Email: Tei twos: <br />11 sanrpMta) rsnived ,uct holding Ibne (HT). or it IrKUflicisnl HT remslns to eomPbta YES <br />snsyais bNon s~iratlon, slug ACZ proceed wRh requested short F1T analYsea9 NO <br />YIO' LMn ACZ wIN eoMact died for furttler instruction. K mitlur "YES` nor `NO" <br />b YlIXo7Aed, ACZ tvitl proead ~ the mgwsW aneyoea, oven if Hi is expRW, and dots win be quallfled. <br /> <br />auote #: GcJ - W S <br />'ecUPO #. <br />nQ Co : $ <br />reds) #: <br /> <br />Reporgn Siate for compliance testi <br /> <br />. <br />c <br />e <br /> <br />~ Q <br />`o ~ ~., <br />ak ~ <br />U1 <br /> <br /> <br />(J <br />Y- <br />~ <br />~O i <br /> <br />J <br /> <br />J r <br />`~ <br /> <br />~ e'~ <br /> <br /> <br />~ <br /> <br />L <br />~ <br />N <br /> <br /> <br />g <br />}~ <br />~ <br />~ <br />ABU R Wf~L !At 83: !JD 6u1 '7 K X X x <br /> <br />~ Lu W15Lt p l 03~ 112.E ,,,) X X X ~C <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Lbeh SW (Surfsee Webr)' GW (CxouW Wald) ~ WW (Waste WatK)' WN t~~6 Waits' SL t84i0ye)' SO (3d~ • OL (Oi1) • and tsPedM) <br /> s PAGE <br />lv os : i3o~ ~ <br /> o r / or <br /> <br />FRMOA02t.014.03.05 While • Return tatfh sample. Yellow-Retain far Your records. <br />