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ACZ Laboratories, Inc. q(0 ? <br />2773 Downhill Drive Steamboat S 'n , CO 80487 (800) 334-5493' <br />4 <br />0 <br />•-.• • <br /> <br />Name: a ; r Y? 5 <br />Address: '33 <br />_ i ? .r r <br />cy,' <br />Com an : cwxo_rc e y\ v t GO pC?O <br />E-mail: Telephone. ?3 -- (d Co t-( 9??/ <br />Copy of Report <br />Name: E-mail: <br />Company: iTelephone: <br />Invoice to: <br />Name: <br />Company: Address: 3 13 5}, ?. at S? <br />-'e" V Lr, C O so cl0;3 <br />E-mail: aKr_-'r, bl nv.s S{oJC,L • Co Lt? Tele ho e: 303 - Sla - e-14 <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 re ested anal ses, even If HT Ise red, and data will be <br />L3U <br />alified. <br />PROJECT INFORMATION ANALYSES REQUESTED (attach list or use quote number) <br />Quote #: <br />Project/PO #: <br />Reporting state for compliance testin?: <br />Sampler's Name: <br />V\ <br />8 Q <br />, <br />Are an sam les NRC licensable material? <br />SAMPLE • D• ° V <br />o a+ti ass ?g ag 3" Sw t <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 <br />REMARKS/ SAMPLE DISCLOSURES <br /> PAGE <br /> of <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RELINQUISHED BDATE:TI ME RECEIVED BY: DATE:TIME <br /> <br /> <br /> <br />1 S'- <br />FRMADOSO.03.05.02 White - Return with sample. Yellow - Retain for your records. Page 9 of 9