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J <br />jACZ Laboratories, Inc. <br />?773 Downhill Drive Stearnboat Springs, CO 80487 (800) 334-5493 <br />E <br />0 <br />q <br />Name: ; <br />Address: 40T - 5t&-t . <br />-7- <br />Company: 4b O A Q3o2- <br />40M Telephone: Q 442-1,0,62 <br />= E-mail: <br />Compan Tele hone: <br />Name: Address: <br />Compan : <br />E-mail: Telephone: <br />If sample(s) received past holding rune (H-r), or if insufficient HT remains to complete YES <br />analysis before expiration. shall AC7. proceed with requested short H1 analyses? NO <br />.. . .. :r.v.. :.x ': u,xr.u n+;nr nw, i., .r '.f lam. nr ,. , .r,.,v,n v• pxc *. .rim .. n:cr iraia <br />Arc sarnpies lot SDWA Cotnphanrc Monrtermg? Y No <br />It es. please include state forms. !Results will he reporwcl to POL for C olorado. <br />Sampler's Name Sampler's Site Information State Lip code rime lone <br />quote #: 52/ <br />Project/PO #: C <br /> <br />Reporting state for compliance testing: o <br /> <br />Are any samples NRC licensable material? Yes v <br />o <br /> <br /> <br />mo ¢ -1 ?J 3 <br />i 4.0 <br /> <br /> <br /> <br /> 3 <br />?-.'Sfl <br />2 tI !P,6 <br />2- r !r/4 30 <br /> <br /> .I ).I 15r1)- <br /> <br />Matrix SW (Surface Water) GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) - SL (Sludge) SO (Sat) - OL (Oil) • Other (Specify) <br />Please refer to ACZ's terms 8 conditions located on the reverse side of this COC. <br />3 4' 0? <br /> <br /> <br />FRMAD05c.02.17.10 While - Return with sample. Yellow - Retain for your reeordS^ <br />?.??11 412 of 12