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<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />U <br /> <br />ADZ Laboratories, Inc. ??? • . <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-549 <br /> <br />Name: NlC\ Address: VQ Wyk- <br />Company: ?CJ1? CSl -@?NOC O Q\z <br /> <br />?j , ' \ . d1\\5 X ?'?JCJ <br />E-mail: O?V?\'`\ . Vag O U'? Com•\?? V??S+ Telephone: <br />Copy . Report to: <br />Name: -WO'C 5 5 <br />Com an : Q\?t3P?SS\S Telephone:21 0t + l> °l\\5 X \p <br />Invoice to: <br />Name: \01\M\ Address: <br />Company: <br />E-mail: ?QC(? 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 C(3(\1>.?( <br />If *NO* then ACZ will contact client for further Instruction. If neither "YES" nor'NCY \SJ?? <br />Is indicated, ACZ will proceed with the requested analyses, even if HT is expired, and data will be qualified. <br />re samples for CO OW Compliance Monitoring? YES -mar, <br />H yes, please include state forms. Results will be reported to PQL. NO <br />PROJECT INFORMATION ANALYSES REQUESTED (attach list Of us e quote number) <br />Quote #: 1M` <br />Project/Po #: IVY U5 \ . 7- <br />Reporting state for compliance testing: <br />Sampler's Name: tg <br />anysamples NRC7icensalile material? Yes o <br />A <br /> <br />r ONW0A \11 I <br /> ?\?tU?CA \? ?`IJ J d <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 (ON) • Other (Specify) <br />REMARKS <br />VRAzm_ *UM C2_IPM \-c\W am,- \ r`(`c hV tj?`(is- 0.% c rv_'Iz, <br />\vn \ac(\, oa _ ??pc\,d?SSO?•ie?? ??\ t.??ct\,?o?t?,\ ? cc?ae- o.S ?.i *,;W-0 <br />acc?e,?? ?Statt\ d??',sa\?i?.c1.s?• ?c?\ =r?atoae-lr??e?.? ?\ <br />tr c?\ b?\\Ct?\?n ' Mr CmGO*b"?'•?\?R <br />CG\GV•C?\ <br />5 J <br />. <br />? <br />CV\G\1KM j x\15\ - ??RSQ- 0\ \U C\ " n? 4+Mo?t?SJ <br />f thi <br />id <br />(36C <br />lo <br /> <br />.. <br />s <br />arse s <br />e o <br />. <br />Please refer terms & conditions <br />RELINQUISHED : •ATE:TIME RECEIVED BY: DATE: TIME <br />(tut ?, ? 2 X51 <br /> <br /> <br />FRMAD050.01.15.09 <br />White - Retum with sample. Yellow - Retain for your records. <br />Page 17 of 17 <br />