Laserfiche WebLink
AGZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Spn • , CO 80487 (800) 334 - <br />93 <br />Address: „�: hi ; ,1/ .S <br />Name: <br />Compan: UEL <br />F ii, _.. J I(; • <br />E-mail. Ae /, II <br />Tele • • e: C _ , 3 <br />Name: <br />E-mail: <br />Com• : n : <br />Tele. one: <br />Name: .. 4M E <br />Address: <br />Company: <br />E -mail: <br />Telephone: <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall AC7 proceed with requested short HT analyses? NO <br />If 'NO' then ACZ will contact cheel la further ,natruction t( mother ' nor "NO' <br />a Indtceted ACZ ash proceed w4h the requested analyses, even A HT is expired and data Asa he qual.hed <br />Are samples for SDWA Compliance Monitoring? Yes <br />If yes, please include state forms. Results will be reported to PQL for Colorado <br />Sampler's Name Sampler's see Information State <br />Zip code <br />Time Zone <br />Quote #: <br />N <br />ProjecUPO #: LJ rt is 1 & L D <br />A <br />Reporting state for compliance testing: <br />o <br />Check box if samples include NRC licensed <br />IOW — ."3 <br />material? <br />d 4-Ii 1 9)P <br />Gw <br />0 <br />o <br />f <br />Nl vii - (5 <br />p -ri-it/ y6) <br />&W <br />3 <br />Matrix SW (Surface Water) - GW (Ground Water) • WW (Waste Water) • OW (Drinking Water) • SL (Sludge) • SO (Sok) • OL (Oil) • Other (Sway) <br />PL RE-rLA/kJ cm. ER <br />.a- <br />Et <br />0 . <br />Please refer to ACZs <br />/i c <br />W SC rri— -S <br />terms & conditions located on the reverse side of this COC. <br />L, o-or <br />IMIIINIAIIIIIINIMII <br />FRMAD050.02 11.11 <br />White - Return with sample. Yellow - Retain it r your records. <br />Page 12 of 13 <br />