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Laboratories, Inc. ~ ' <br />773 DownhBi Drive Steamboat Spnrgs, CO 80487 (800) 334-5493 Ly L ~ ~ <br />Name: ~ ~ Address: - <br />Company. Q (,~, / 2 Z~ <br />E-tna1: Telephone: /r 7~ ~ <br />Name•• e C £-marl: ~-~ S. Wei a6 <br />Company: O.-~P1' ~ - frt) Telephone: - (a Z/o0 <br />Name• ~ <br />O~ Address: <br />n <br />E-mail: Telephone: --lo ~ p~ <br />sample(s) received past holding time (HTj, ar if insulfident FiT remains to complete YES <br />analysis before oxpiration, shall ACZ proceed wdh requested short HT analyses? NO <br />( "NlY' than ACZ will contact clierrt for further Instruction. If neither "YES' nor "NO" <br />is indicated, AcZ will proceed with the requested analyses, even if HT Is atgrlred, and data will be qualified. <br />~e a- • • ~ <br />Quote #: <br />Projed/P0 #: ~ Y1 <br />` <br /> <br />Shipping Co.: m <br />~ <br />w <br />Tracking #: V <br /> 1 <br />Reporting State for canpliance testing: o '7, <br /> ~ ~1 <br />^ • s• <br />A• D.~ /2;ZD <br />-Z- ~~ /Z,r/ Gtr? <br />D~ '~ D`od ~ ~. <br /> •/ / ,'oU 6cJ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Natriz sw (sudace wain ~ ova (Gmuna watep ~ ww (waare watep ~ ow (DrYrang water) ~ u (sNdge) ~ so isdq ~ of (aq ~ aver ispedry) <br />• ~ , . t s ~ PAGE <br /> ~~ <br /> OF <br /> <br />FRMQA021.06.03.05 <br />Yahite - Retum xittl sample. Yellvu -Retain for yore records. <br />,~. 'CD <br />L43419: Page 10 of 11 <br />