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~sa~3 ~ldJ3~~°d, <br />u-+~z-, ~a•~4~, <br />Laboratories, Inc. . , <br />2773 Davnfr9l Dave Steamboat Spnrga, CO a0487 (800 3945499 <br />Name: Address: <br />Co an <br />E-mail: T hone: <br />.. <br />Name: E-mail: <br />Corn Tele hone: <br />Name: Atltlress: <br />Corn n <br />E-mail: Tale one: <br />M sampls(a) rsosNed past troldlne time (F{T), or iT lnauTacisnt HT remains W eamplete YES <br />analysis before axplredon, ahea ACZ procoed with rsqusstatl stwrt HT analyses? ~ NO <br />M'NO'then ACZ will Co11iBCt client for further Inetrecroon. M mmror "YES" mr "NO" <br />Is Mdkatod, ACZ will proceed wIM tlw requastatl analyses, even If tiT Is expred, aM data will be qudMlW. <br />•• •• • • r <br />OuOQB #: ~ <br />Pro ad/P0 #: -iy ~ <br />Re rtin state Tor corn liance testin <br />Sam er's Name: - v <br />Are en samples NRC IlcensaWa material? ~ ~/'~ <br />. r~ <br />d ~ ~ <br />07 O <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />aKtrb SW (SUie<a WaOer)' OW (Gnwnd Well) • W W (Week W.ISr) ~ nW (DrlNdnp Wets)' SL (SIU4GU' 80 (adq' OL (ON' 01her (apeelN) <br />Please refer to ACZ's terms 8 cord'dions loceled on Mle reverse side of this COC. <br />• .: s. s e s• <br /> <br /> <br />FRMAD050.03.05.02 White-Return with sample. Yelbw-Retsin for your n~cords. <br />/I <br />L60358: Page 7 of 7 <br />