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Laboratories, Inc. <br />2773 Downhfl7 Drive Steamlwal Springs, CO 80487 (800J 334-5493 ~ ~ ~ <br />Name: ~ <br />e <br />nO,t/ Address: ,~ r-f~ <br />// <br />ee ~ <br />Company: LO enl~ ' c5 J ~-~ <br />E-mail: Telephone: 7S' - G <br />Name: t~ e- E-mail: <br />Company j-~'O R/ Telephone: 9-~lo Z.fo~ <br />Name: ~ g ~ Address: <br />Company: ~/ Z7~ <br />E-maiL• Telephone: <br />t(sampla)s) received past holding tlme (H7), or if Insufllclent HT remains to complete YE5 <br />nelysls baforo ezpiratlon; shall ACZ proceed with equested short HT anayses? NO <br />If "NO"then ACZ will eontaci client for further instruction. If neither "YES" nor "NO" <br />la Indicated, ACZ will proceed with the requested analyses, even If HT Is ezpUed, and data will bs qualMed. <br />-e e- <br />UOta #; <br />ProjectlPO #. 5 <br /> <br />Shipping Co.: <br />Tracking # <br />Reporting state for compliance testing: <br />Ara any samples NRC licensable material? <br />m <br />~ <br />p <br />c <br />~ 1 <br />S <br />a . ~. <br />_ ,z r / .'~' era 3 x <br />~ -o ,~ ~~~~ ~~ ~ x <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />MaViz SW (SUrtece Water) • GW (Ground Water) •WW (Weals Water) ~ DW (Drinking Water) ~ SL (Sludge) ~ 50 (So0) • OL (OIp • Otlzu (Spedfy) <br />a ~ . ~ ~ . Pa <br />ge <br />i `~/D D / <br /> c.-... ~/5-D Of <br /> <br /> <br />(=RMQA021.12.03.06 <br />White - Retum with sample. <br />Yelto - e m fot o recur s, <br />