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•/CZ Laboratories, Inc. (, <br />2773 Downhill Drive Steamboat Sprin s, CO 80487 0)3 <br />Report IfJA A. COLL10t_ <br />I(D <br />o - <br />E-m <br />Jame: O? ON R. SL,) E E-mail: t--qswp-ene-? Ulu :om an : 0 1...>E VC 0 Tele hone: O - '06565-'-5414 <br />nvoice to: <br />Address: <br />Name: <br />Com an 01 <br />E-mail: Telephone: <br />If sample(s) received past holding time (HT), or If Insufficient HT remains to complete YES <br />NO <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 ired, and data will be qualified. <br />uote'-tZZ - MO ITOR1N6 124 <br />4) 77 7 <br />Project/PO #: <br /> <br />Co E <br />ce <br />compliance testin <br />Reporting state for a <br />Sampler's Name: i? INA U <br />--H 0 <br /> <br />0 <br />Are an Sam les NRC licensable material? 0 <br />- ?, <br />On$d - W N 8 q <br />E <br />C <br />Z. <br />. <br />Z iI o$ 10: t M 2 <br />o? 11 + - w3 It o8 9: yes AM <br />? C. Z <br />5 <br />N JO oDtl - ? f?W Z <br />2 <br />g S 31 _ NA + 8 Ig <br />? <br />- <br />06 Gtin( <br />6 ?o?u <br />w 4 <br />? <br /> - <br />?' ,y ? Z <br />?; OO??tt ?" PAND 3 ??$ <br /> MWt <br />o ppgo? it1 <br />tti <br /> Wy altt O tl <br />Od O t + ., , <br />GW (Ground Water) wW (Waste water) D <br />(Drinking Water) SL (Sludge) SO (Soil) OL (Oil) Other <br />cam. Matrix SW (Surface Water) • <br />? a ooSo?+1 - ???F 3??r 1e?8 Ik?r? G'vlr ! 2 <br />Qt gDAQ, Su <br />L! <br />>y? <br /> <br />FRMAD050.03.05.02 White - Return with sample. Yellow - Retain for your records. L68110: Page 31 of 32