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~.nHUV ~r t,ua t vu r ntt,unu ~ ~ `, ~ i f , I I ~ i- ~ <br /> RESULTS T0: BILL TO: ' <br />~'7 <br />ACZLaboratories <br />Inc. ~5e"~~~- C.:~• ~ - ~( .y`-~~""~ I1~G~~-Q~r - ~ ~`t~i <br />, <br />30400 Downhill Drive <br />Steamboat Springs CO 80487 <br />(303) 879-6590 !8001 334-5493 Attn: ~~ L~ c•, ~ v Tel: Attn: Tel: <br />PRO CT or P.O. p N ANAL YSES REQUESTED <br />~~t n-Q c z ~ ~ ~ ! I <br />SAMPLERS: 1 ipnature/Print Namel a ri h ./ r, ~ REMARKS <br /> <br />~ I~U~ <br />p <br />u <br />~ <br />~/ <br />~ <br />/~~ <br />~ <br />N\ ~ <br /> <br />ti ~ <br /> <br />a <br />SA LE IDENTIFICATION DATE TIME SAMPLE # ~a-._ ~ Sl r.+p <br />~^ /J C <br />h ~ v0 <br /> MAiR1X <br />-~-'V-N ~:-00 irl / 90p `'ul ~ ~ / v V !~ v <br />U LEuavx Hr</r:,,.oct_ <br />W '-N P- (7 t) Z rl l/ l' ) y LEN NCK If141~w,oL L. <br /> <br /> <br />,2W ` N - DO 3 /t '~ /~ a ' Gr`hD~O Si~cl I_ <br /> <br />.2W ' $ 'dog /p /y /oU0 n.• ° C.IZADE~ S~c~L_ <br /> <br />.ZGt/ !3 -` (~O lro <br />n <br />/r <br />'~ <br />v, V+ V <br />o ~ <br />., <br />LEU tJOx HI(. NL•JRLL <br /> F p <br />~W .,B - po ~ ' l /' " ~'"" c I-I:NNI`X 1`~14ra+.;a~L <br /> <br />W " B - 00 <br />/ / <br />r' <br />/ / <br />~/ <br />~/ <br />V <br />w <br />' <br />° <br />~ °J ~ y <br />~j <br />G,RADEJ Spot L <br /> <br />HAND <br />OTHER <br />METHOD OF SHIPMENT: FED X <br />UPS COMMENTS <br />_ <br />_ <br />_ <br />_ <br />SAMPLE D/SPOSAL OPTIONS - Pleese comp/ete section A, or choose one option /iom sections B AND G ~~ # ~v ~ j {-~ C U /~+ ~ N{, <br />Pro er char es wi71 be sssessed. - <br /> <br />(A/ Long-term storage <br />(BI K Sample is Non-Hazardous <br />(C) !f Sample is Hazardous ~ <br />5 i"~ (t A/Ly ~~ e ~~> T ~ <br />Hold until (date) <br />l <br />f 1) Local Disposal <br />ili <br />A <br />d F <br />2 <br />R 11 RCRA-Permitted Facility <br />R <br />Cli <br />2 _ _ <br />z - ~~~ y s z s 3 F~~z A~~/ >-,„-° <br />d <br />uture ana <br />ysis. <br />for -Permitte <br />1 <br />CR <br />ac <br />ty eturn to <br />ent <br />1 r= <br /> 3 Return to Client /'~ F~' <br />RELINQ HED BY: (SIGNATURE) DATE TIME RECEIVED BY: (SIGNATURE) DATE TIME PAGE / <br /> i~'-1 G~ ~ ~ ~ I~o3 ----~-- <br /> OF <br /> <br />~Ite -Return w/sample Yellow - Return wrsemple - F'Ink -Return W/Sample ww- Rung wi tv~_coras <br />