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Laboratories, Inc. <br />2773 Downhill Drive Steamboat S <br />prings, CO 80487 (800) 334-5493 7 ~ ~ <br />p <br />Name: I l t „j d-Q(,~~ Address: l7 <br />Company: ~ j deco p~ <br />E-mail: ~, 47 Telephone: ~ - ~j0 <br />•.. <br />Name: ~ ,? E-mail: v~$ <br />Company: Telephone: 3G ~ -~ ~ ~ <br /> <br />Name: - Address: t <br />Company: 109, ~~ ( O I <br />Email: '@ ~,u + Uq Telephone: p~ <br />M sample(s) reeelved past holding time (HT), or if Insufficient HT remains to complete YES <br />analysis before expkagon, shall ACZ proceed with requested short HT analyses? NO <br />If "NO" than ACZ will contact client for further Inatructlon. It neither "YES" nor "NO" <br />Is indicated, ACZ will proceed with the requested analyses, even if HT is expired, and data will be qualified. <br />•e s• • • ~ <br />QUOfB #: (~/ <br />ProjecUPO #: 4 c~ 1. Z <br /> <br />Shipping Co.: m <br />~ <br />~ <br />' <br />Tracking #: ( <br />0 v <br />0 <br />Reporting state for compliance testing: U 1, <br />o <br />i0 <br />Are any samples NRC licensable material? No 3 <br />t • s • ~ ~l <br />w ~ao e Iscv' G <br />~~ 6 <br />w - oo 'l 6 <br />pt1 - Lb6 6 <br />- x <br />~ 1 r <br /> <br /> <br /> <br /> <br />MaMZ SW (Surface Water) Grountl Water) ~ W W (Waste Water) ~ DW (Drinking Weler) - S[ (Sludgel ~ Sn (Brit} ~ OL (Oil) • Other (Specityj <br />r • • r e ~ • Page <br />S ~1 <br /> Of <br /> <br />FRMOA021.12.03.06 White - Retum with sample. <br />