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i <br />ACZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Name: a Address: 1C ?` <br />Com an w t O ?/ <br />E-mail: V-? CtD*,N ?• t'1A? i • ??+ Telephone: W '7 pq- 6 3 9, <br />E-mail: j (Telephone: ' ;) 78V <br />If sample(s) received past holding time (HT), or If Insufficient HT remains to complete <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <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 qL <br />PROJECT INFORMATION ANALYSES • i (atta <br />Quote #: 775 In <br />Project/PO <br />c <br />Reporting state for compliance testin : <br />Sampler's Name: <br />w <br />Are any samples NRC licensable material? ° <br />YES <br />NO <br />I • ? <br />l r ,'DDf-?- ?( <br />- ? - 7S.0 <br />p ., l f f ; S!h 11 <br />Matrix SW.(Surface Water) • GW (Ground Water) . WW (waste Water) • DW (Drinking Water) • SL (Sludge) . SO (Soil) • OL (Oil) • Other <br />MARKS/ SAMPLE DISCLOSURES <br />re/ <br />r• 5 ?4? &f0-,`Q i PAGE <br />of <br />Please refer to ACZ's terms & conditions located on the reverse side of;this <br />"s <br />FRMAD050.03,05.02 White - Return with sample. Yellow - Retain for your record!rQgG 1 4 V1 1 V