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~L'iZ Laboratories, Inc. LS~3Sq • • <br />2773 t7ownhfll Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />•.. <br />Name: ~ ~ L- - f? ~ Address: ,p <br />Com an : tp 2~2-,(0 <br />E-mall: Pe•' ~, 1"*`n .. 71(e'T Tele hone: ~... <br />.. <br />Name: p.tiJ <br />E-mail: p ,,,) ,~ <br />Com n : ~ C..~. Tele hone: <br />Name: , <br />~ Address:. <br />/t~ <br />Com an : `O - ~/2,Z(o <br />E-mail: ,~.~ t Tele hone; ~ (o ~ <br />ff sample(s) received past holding time (HT}, or if insufficient HT remains ib wmplete YES <br />analysis before expirellon, shall ACZ proceed with requested short HT analyses9 NO <br />H "NO" than ACZ will wntad client for further InstruUlon. H neHher "YES" nor "NO" <br />is Indicated, ACZ will prowad with the requested anatyses, even H HT is expired, and data will be quallfled. <br />-a •- s <br />Quote #: Q O <br /> H <br />Pro ect/PO #: m <br />c <br />Re rtin state for com liance testin : ~ <br />Sam IeYs Name v <br />Are an samples NRC licensable material? ° <br />. • a~ <br /> <br /> !/ k <br /> 11 ;0 C~L~ <br />p_o ~~ iz: <br /> <br /> <br /> <br /> <br /> <br /> <br />MaMx SW (SUrtace Water) ~ GW (Ground Wetar) ~ W W (Waste Water} • DW (Ddnlung Water) ~ SL (Sludge) • SO (Soip ~ OL (Oip ~ ONer (Spedry) <br />Please refer to ACZ's terms & conditions located on fhe reverse side of this COC. <br />• s c . ~ .: . <br /> 0¢ at o93n <br /> <br /> <br />~s. <br />FRMA0050.03.05.02 White - Retum with sample. Yellow -Retain for your rernrds. <br />L57759: Page 11 of 12 <br />