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l.l'7HU~ ur ~,~~ t Vu 1 nt~,vnu ~ , ', ~`. ` I (,- I ~.,, I I <br />i i ~~ <br /> RESULTS TO: BILL TO: ' <br />ACZI_aboratories <br />Inc ~ Se~.F~~. C~~. ~ f( .ti`-~~=`t ~~c~~Qy - ~ ~~t~l <br />, <br />. <br />30400 Downhill Drive ~.T- <br />Steamboa[ Springs CO 80487 <br />(303) 879-6590 (8001 334.5493 Attn: ~' i,~~..~, v Tel: Attn: Tel: <br />PRO <br />CT or P.O. N ~ ANAL YSES REQUESTED <br />~ <br />~.t3 ~' ~ w ~, ~ <br />I <br />SAMPLERS: ISipnature/Print Name) _ <br />¢ ~ h ~ r. ~ REMARKS <br />f, <br />~ Vl~t~p <br />o <br />~ <br />~ <br />%a ^' <br />N ~ ~ <br />~ ~ <br />_ <br /> U 1~ ~ a <br />SA LE IDENTIFICATION DATE TIME SAMPLE ~ ~~ ~ ~ <br />~ro ~ C <br />h ti <br />~ ~ <br /> MATRIX <br />~h/-N <br />~.- <br />p <br />- <br />0 io / 9~0 `•~l ~ ~ ./ ri r~ (i v v ~fuavx Nr~r+.~act_ <br />p <br />7 <br />7 <br />' <br />, <br />~C /'t~ ~y~ I V~ L /~ // // ) ~j LEN AiCX 1~11.I~W~OL L~ <br /> <br />.Z W ` N -- Do 3 .. ,, ~~ c ' GRn~C-D s,~oi L <br />W N h .. G „ ~r ri ~ $ ~,Zr~DFq 5?c~i- <br />.ZW "' $ -OOg /0 iY /000 ~~ o. ~ ~IZA1~CD S~c~~ <br /> ~ w LL`ur.IGK HIL,NUS.4C~ <br />_ <br />~W B .. ~O <br />i~ <br />i~ <br />„ <br />~ .. <br />~ t: ~ <br />~ <br />~~ raDcD S~ciL <br />~` [tJ - QO ~ ' ~ " " ~ d.== c LEN,VCx 1.~14~TwaL[- <br /> <br />W -6' - DO <br />r~ <br />!' <br />~i <br />'~/ <br />~/ <br />/ <br />v <br />' <br />° <br />,u~ N <br />v <br />G,RADfJ Slw1L <br /> <br />METHOD OF SHIPMENT: FED X _ UPS _ HAND _ OTHER _ COMMENTS <br />SAMPLE DISPOSAL OPTIONS -Please complate section A, or choose one option lrom sections B AND C. ~() 1~' T () ~ T I-{ C U +N ~ n/ ,l~ <br />Pro er char es will be assessed. <br />lA/ Long-term storage IBI N Samp/e is Non-Hazardous ICI tf Sample is Na:ardous 5 Fl- (~ /-IiLy ~~ c ~'~ T t~ <br />Hold until (date) <br />f <br />l <br />f <br />t <br />i 11 Local Disposal <br />i <br />ilit <br />RCRA <br />P <br />d F <br />2 11 RCRA-Permitted Facility <br />r <br />to Clie <br />21 R <br />t <br />t p~~, Tic,~'~ <br />d~z - ~~ y s z s 3 FUi2 - <br />u <br />ys <br />or <br />ure ana <br />s. - <br />erm <br />tte <br />ac <br />y <br />1 u <br />n <br />n <br />e <br /> 3 Return to Client /A, Fu, <br />RELINQ HED BY: (SIGNATURE) DATE TIME RECEIVED BY: (SIGNATURE- DATE TIME PAGE <br /> i~'-/ G~ I~o3 ------- <br /> OF <br /> <br />~Ite • Return w/sample Yellow - Return wlsample - Pink -Return wlsample tiut_u -Keep ror yot~tords <br />