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a <br />L [P 3Sly <br /> <br />ADZ Laboratories, Inc. • . <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800 3345493 <br />Name: Address: <br />Company: A"Ar <br />E-mail: Telephone: <br />Name: E-mail: <br />Com an : Aw. PN "tt Tele hone: •. <br />Lam <br />Name: Address: <br />Company: t <br /> <br />: <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 AM will contact client for further Instruction. If neither "YES" nor "Na' <br />is indicated, AM will rowed with the uested ana s, even If HT is ex Wad, and data will be qualified. <br />PROJECT • <br />Quote #: O <br />Project/PO #: <br />Reporting state for com liance testi : <br />.Samplers Name: <br />les RC licensable material? <br />Are an sa <br />W <br />• • 11121111111MI M <br />V <br />60 Wi- a /Z 'A3 1w <br /> lr 2'I W 3 <br /> <br />A a. +? ?Z GvJ 3 <br /> n I l 6W <br /> <br /> SW <br /> <br /> f l 4J <br /> <br />M 14 7A 116, 131:0 L I - <br />Matrix SW (surface water) G W (Ground water) ww (Waste water) ow (Drinking water) si (sluiye) so (sou) oL (ai) other csPsaryl <br />IUpT aArw ter r H caA cvv? TP.S <br /> <br /> <br />ae_ Aft IM <br /> <br />? , Grp N <br />otr ?, Fe I , M I M# t ? , ZN, svl , d ? 3 <br />y <br />C <br />A 5,W) VOW) <br />Please refer to ACTS terms & conditions located on the reverse side of this COC. <br /> <br />-0?- <br />1L. AA <br /> <br />t <br /> <br />FRMAD060.03.05.02 White - Retum with sample. Yellow - Retain for your records. <br />I L63514: Page 24 of 24