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_...:~ <br />Laboratories, Inc. ~ ' <br /> ~ ~7~ <br />~ ~ <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Name: µK{- Address: /3 <br />e <br />Company:. <br />E-mail: Telephone: (y <br /> <br />Name: E-mail: <br />Company: Telephone: <br />Name: Address: S <br />Company: <br />E-mail: Telephone: <br />I} sample(s) received past holding gme (HT), or If InauPocNM HT remains to complete . YES <br />analysis before e>tplretion, ahaIFAC2 proceed with requested short HT anelysas9 NO <br />If "NO" than ACZ will content client for Nrther Instruction. M neiflter "YES" nor "NO" <br />Is Indicated, ACZ will proceed with the requested analyses, even It HT Ia expired, and data will ba quaSfled. <br />"e a• e • r <br />Quote #: <br />Project/PO #: ~ <br />Shipping Co.: <br />c <br /> <br />Tracking #: c <br />Reporting state for compliance testing: ~ yJ <br />sl <br />Are any samples NRC licensable material? <br />e • e• # <br />~~ ~ <br /> <br /> 31D <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Mertz SW (Surface Water) • GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • SL (Sludge) • SO (Soi6 ~ OL (Oip • Other (Spedry) <br /> <br /> <br />~ 1: 1~ ~: ~ r Page <br />I <br /> Of <br /> <br />FRMOA027.12.03.06 <br />White - Retum with sample. Yello v~~l~fo~y2&g ~~i~ <br />