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ADZ—Laboratories, Inc,�1,�-`t��,D <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 -5493 <br />Name: .—., C-rSeiJ Address: <br />Company: O <br />O <br />E -mail: e, C Nr—'i Telephone: _ <br />-- <br />Name: E -mail: <br />Company: Telephone: <br />Name: Address: -d � <br />Company: �c� 0 <br />tEl <br />E -mail: Telephone: -- 719 <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete <br />YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />NO <br />It 'NO Then ACZ will contact client for further instruction. If nalthr -YES- Wr 'NO" <br />is indicated. ACZ will proceed with the requested analyses, even If HT is expiretl, and data will be qualified. <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Na uJt YV, mplcr's site Information State <br />Zlp code <br />Time Zane <br />Quote #: `^ <br />ProjectlPO #: <br />W <br />ro <br />Reporting state for :ind'ude, nce testing: p <br />p <br />Check box If sampl NRC licensed material? <br />U <br />o <br />r <br />r <br />7( <br />I <br />:3 <br />Matrix SW (Surface Water) GW (Ground Water) - WW (Waste Water) DW (Drinking Water) • SL (Sludge) SO (Soil) • OL (oil) Other (Specify) <br />Please refer to ACZ s terms & conditions located on the reverse side of this COC. <br />7!7 <br />