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ADZ • Laboratories, Inc. <br />2773 Downhill Drive Steamboat Spnngs, CO 80487 (800) 334 <br />Name: „IA - ec& Kt K � <br />Company: 6 DiptP.r 4S15oA1 S <br />E -mail: ' v d—ki e ( e r•c:ow1 <br />Name: $r( Qr kj its <br />Company: o1cIer ASSoe43" <br />Name: Scl,I -- 4 licit kt45 <br />Company: Cej A556< \4kG <br />E -mail: 54 r - kfr Z ' abide r,(0V4 <br />Project/PO #. <br />Reporting state for compliance testing: <br />m1il - p 2 <br />0/141 t3 <br />wit) -f5 <br />pti w.. o`l <br />It jr-!il 115t <br />11 jr�1 r ( 1 <br />1 I2,49 <br />n <br />If sample(s) received past hold+ng time lHT), or if insufficient HT remains to complete <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />11 NO then ACZ wdt contact cIuent for `urther knstrucinor If nether YES nor 'NO <br />is indicated ACZ will proceed with the requested analyses even if FIT is expired and data will be qualified <br />Are samples for SDWA Compliance Monitoring? Yes I I No <br />If yes. please include state forms. Results will be reported to PQL for Colorado <br />CO Zip code <br />N[ - I I 075b CA) <br />(1/M 1036 `t <br />I( /1 #111 M45 47 <br />6E0 <br />C74) <br />CMJ <br />Address: if q ti rQ <br />Sates 300 tctkrto, CO 70 <br />Telephone: 363 _ 9 'ed —05 O <br />E -mail: $a {I,atr kths vebE cc% <br />Telephone: 303 —q8 <br />Address: y y a t Wt <br />Lakk)oerl CO 802,28 <br />Telephone: 303 — q gc7 -- 6S i/0 <br />u <br />Sampler's Name <br />t) 14, <br />Sampler's site Information <br />State <br />Quote #: {4 ()Le1vti -67(o <br />c <br />its <br />c <br />0 <br />Check box if samples include NRC licensed material? <br />U <br />0 <br />278 Time Zone <br />UCI <br />YES <br />NO <br />Matnx SW (Surface Water) GW (Ground Water) • WW (Waste Water) - DW (Drinking Wate) • SL (Sludge) • SO (Soil) OL (0 Othe (Specify) <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />AVIV] L Ell I WE <br />FRMAD050.02.11.11 White - Return with sample. Yellow - Retai or your records. <br />Page 36 of 36 <br />zz �' <br />