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Bottle Order <br />Packing List <br />ACZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 -5493 <br />Account: ARCADIS /ARCADIS U.S., Inc. <br />Bottle Order: B025214 <br />Sampling supplies <br />PACK Qty ACZ ID <br />T ype <br />Description <br />I <br />1 <br />2 <br />1 <br />10 <br />ACZ Coolers <br />COC <br />SEAL <br />RETURN <br />LABELS <br />2891 <br />Small <br />Quote number: HOLCIM -SHORT -2011 <br />Sample Quantity: 2 <br />Prepared By /Date: <br />GREEN <br />1 WHITE <br />l <br />250 ML Filtered <br />Chain of Custody <br />Custody Seal <br />Return Address <br />Sample Labels <br />PACK Qty ACZ ID <br />Size • Weight <br />Quote number: HOLCIM- SHORT- 10 +FE -T <br />Sample Quantity: 2 <br />PACK- Qty Type <br />RED 250 ML Raw /Nitric <br />1 GREEN 125 ML Filtered/Nitric <br />1 WHITE 250 ML Filtered <br />125 ML Filtered/Nitric <br />Bill to Account: <br />Ship Date Requested: <br />Request Placed at: <br />Service Requested: <br />Chain of Custody, 1 for 10 samples. <br />Custody seals for cooler, two for each cooler. <br />Return Address label, one for each cooler. <br />ACZ supplied labels for sample containers <br />1Z8101300306230349 <br />Hcicim Site - Short List - 2011 + Total Iron <br />ACZ is responsible for necessary sample filtering <br />Holcim Site - Short List - 2011 <br />ACZ is responsible for necessary sample filtering <br />Bill to ACZ <br />03/21/2011 <br />03/18/2011 10:10 <br />UPS Ground <br />Size Filter /Raw /Preserve. <br />Metals (total except ICPMS) - Do not overfill as there is Nitric Arad <br />in the bottle. <br />Metals (dissolved except ICPMS) - This is a filitered sample. <br />Completely fill container. <br />Wet chemistry (dissolved) - This is a filitered sample. Completely <br />fill container. <br />PACK Qty Type_'. <br />Sizel. Miter /Raw /Preserve;`' Instructions <br />Metals (dissolved except ICPMS) - This is a filitered sample. <br />Completely fill container. <br />Wet chemistry (dissolved) - This is a filitered sample. Completely <br />fill container. <br />SW <br />Page 1 of 2 <br />Page 14 of 14 <br />