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ACZ Laboratories <br />Inc <br />, <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />. Aim <br />Name: Address: <br />Company: <br />E-mail: Telephone: <br />Re <br />ort Copy of <br />p <br />Name: E-mail: <br />Company: Telephone: <br />Invoice to: <br />Name: Address: <br />Company: <br />E-mail: Telephone: <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />If "NO" then ACZ will contact client for further instruction. If neither "YES" nor "NO" <br />is Indicated, ACZ will proceed with the requested analyses, even if HT Is expired, and data will be qualified. <br />PROJECT INFORMATION ANALYSES REQUESTED (attach list or use quote number) <br />Quote #: <br />ProjecUPO 5 <br />Reporting state for compliance testing: <br />Sampler's Name: 0 <br />w <br />Are any samples NRC licensable material? ° <br />SAMPLE IDENTIFICATION DATE:TIME Matrix <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Matrix SW (Surface Water) - GW (Ground Water) - WW (Waste Water) - DW (Drinking Water) - SL (Sludge) • SO (Soil) • OL (Oil) - Other (Specify) <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />--- <br />RELINQUISHED BY: D• RECEIVED BY: DATE:TIME <br />A <br /> <br />FRMAD050.03.05.02 White - Return with sample. Yellow - Retain for your records.