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Lai <br />ACZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Spnngs, c:u tfu4ur (uuu <br /> <br />Report Name: ) <br />iodG, <br />aag-o <br />) <br />wao <br />Address: 000 O 3 2; D <br />t <br />r <br />TvvGr a.,/ A0f0 <br />an : ) <br />F <br />Com <br />ef& L /`w.r la-le-A-.20 D ?f <br />. <br />. <br />p <br />-- <br />rt t <br />E-mail: e- j; 4a G r• G n Telephone: Q l0 <br />, <br />Copy of Report to: <br />Name: Git r' <br />- <br />E-mail: r vsJ?4 /GSouiYLS e <br /> <br />s G oU /GG LL <br />an <br />Ab le <br />Com <br />Telephone: O Z <br />?- <br />p <br />& <br />Invoice to: <br />Name: l• /- r Address: D AaK Al.? S <br />Company: i G o ?' G D Z <br />E mail: .trf . G r y, v/t+ Telephone: a T <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. tf neither "YES" nor "NO" <br />is indicated, ACZ will proceed with the requested analyses, even if HT is expired, and data will be qualified. <br />PROJECT INFORMATION ANALYSES • ¦ (attach list or use quote number) <br />Quote #: a <br />Project/PO #: C <br />Reporting state for compliance testing; <br />0 <br />Samplers Name: Co at ki V <br />0 <br />Are any samples NRC licensable material? /l/D at <br />SAMPLE ¦ ¦ DATE:TIME Matrix <br />N t ? flt? o <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />;0^ <br />L67328: Paee 17 of 17 <br />FRMAD050.03.05.02 White - Return with sample. Yellow - Retain for your records.