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<br />qCZ Laboratories, inc. C? (?.(0 3 q ?- • • <br />2773 Downhill Drive Steamboat Springs, CO 80487 800 334-5493 <br />• - • <br />Name:LWA COL L INS Address: Aaft. 941 <br />Company: MoUn+ TZ V1 M &V161jer CO 03 - Z_+64 <br />E-mail: l1 h hus?jlcj N. CO Telephone: _*ZQ ":56 5 - 344fe <br />Copy • Report to: <br />Name: G N GW Y E-mail: sW n iT <br />Com an : H) Qunf' ro?OW A?kr4 s Telephone: _ 48 <br />Invoice • <br />Name: Address: <br />Company, Verdur" A 0604, <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 ACZ will contact client for further Instruction. If neither "YES" nor "NO" <br />Is Indicated, ACZ will roceed with the re Nested ana ses, even if HT is a ired and data will be qualified. <br />PROJECT INFORMATION ANALYSES REQUESTED (attw:h list or, use quoIg num ber) <br />Quote #: ?Nwfln L ?WI ?Pl 6 <br />Project/PO #• c <br />Reporting state for compliance testin : <br />Sam ler's Name: <br />Are an samples NRC licensable material? <br />• <br /> <br />00-ILI I i - -40 <br />f 1 4 15 GW <br />MW 5 1 <br />001f tit 91 1- ?- t4, of G. <br />Do,* 1119 -Wy H :a GW <br /> _ <br />Qmlj?q ` _ _ lb,50 t?v/ L4 <br /> <br />pr l`19 -off 1141')r "W <br />1 g - 1-1 15,22N I S <br /> -0?- 13.s8 ??? <br /> <br />Matrix SW (Surface water) • GW (Ground Water) • WW (Waste Water) • OW (Drinking Water) • SL (Sludge) SO (Soil) • OL (Oil) • Other <br />REMARKS/ SAMPLE DISCLOSURES <br />v M+QCLc.( 4m 17s s&,e ' it fid SOA a* 1 Y?uAw o4 6c ` 1*4;S v <br /> PAGE <br />QA1 SCIA)oIC., CW.A- Llnh` / Cep of <br />Please refer to ACTS terms & conditions located on the reverse side of this C C. <br />RELINQUISHED : DATE:TIME RECEIVED BY.- DATE:TI ME <br /> <br /> II' <br /> <br /> <br />FRMAD050.03.05.02 White - Return with sample. Yellow - Retain for your records. L66392: Page 21 of 22 I