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eport to: <br />CHAIN of CUSTODY <br />ACZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334- U0 ,5 1 D <br />Name: Cony Louk/bES <br />Company: M»7/ -EEoN / (MNs 1 <br />E - mail: wry (s1agreS011 /A;4 c'M <br />opy of Report to: <br />Name: DoE LP AllSt) <br />Company: <br />Viiot-c-t vv\ 05 <br />Invoice to: <br />Name: CO/I-L)A'Ii kdrize ,IVifLY5i 5 <br />Company: fti, •r (ifS6N niivI n!C' CMJVStiL A•v 3 <br />E -mail: corva I✓11tileS01 b , Ca/t1 <br />If sample(s) received past holding time (HT), or if Insufficient HT remains to complete <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 re • uested analyses, even if HT is expired, and data will be <br />PROJECT INFORMATION <br />ANALYSES REQUESTED (attach list or use quote number) <br />Quote #: GIN/ <br />Project /PO #: COAL p N &f PSu IM <br />Reporting state for compliance testing: <br />Sampler's Name: / 4 012 LOVE - - <br />Are an <br />sam <br />SAMPLE IDENTIFICATION <br />DATE:TIME <br />Matrix <br />MN a I <br />CvX 1 <br />UN DO <br />ILI 0 1 <br />MCC, <br />FRMAD050.03.05.02 <br />l es NRC licensable material? <br />Coey LwKiD,C 5 <br />Nb <br />31114°03 I LI :2-' <br />3 r1 2oog iq r 35' <br />3 11 20015 14; LIS <br />3I l l 2co /5 <br />ILO Zao$ 15;15 <br />31tiEpos 15: <br />GW <br />White - Return with sample. <br />Gw <br />GvJ <br />(:IN <br />Gw <br />Uw <br />3111 itit 1 <br />Address: ZSOJ YovN6rsE.LO ST. gut t i` 171 <br />Telephone: 30'3 — H 5 -5638 <br />E -mail: T'o'E . Likv p kOI.,Ci 1F'l.. (Dm <br />Telephone: - 7t1— 1S`t 12.09 <br />Address: 2Sbl Y6VN6F1ELr sr Sutit 1.'1k <br />co 5 S O R A <br />Telephone: 3b3- L-1519 ' 5C,59) <br />a� <br />c <br />c <br />0 <br />c0 <br />6 <br />GoL D En) ca 30 (10 <br />GbL,r <br />W <br />W <br />Yellow - Retain for your records. <br />ualified. <br />YES <br />NO <br />Matrix SW (Surface Water) • GW (Ground Water) • WW (Waste Water) • DW (Drinking Water) • SL (Sludge) • SO (Soil) OL (Oil) • Othe <br />REMARKS/ SAMPLE DISCLOSURES <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />RECEIVED BY: DATE:TIME <br />/goo <br />PAGE <br />Z <br />of <br />RELINQUISHED BY: <br />DATE:TIME <br />/- <br />L68214: Page 48 of 51 <br />