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ACZ Laboratories, Inc. <br />2 773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-5493 <br />Name: L u5K.o <br />Lc ta <br />" AIK <br />1 - <br />Address: I 17 <br />(' ' lX g <br />e,, - <br />Company: ARC�A DIs•U3 <br />L `94, co 0 <br />E -maII ..M M..' IW O AtA Pt& • U S • 6'+NV <br />Telephone: l'.4 <br />Names Ct <br />mail:"}'f j 4 . i4oH, 4 VoA AIJ. L r (Ali <br />Company: A QCAOld <br />Telephone( 2.9) go'' 3o5T <br />Name: A 1) ',yet <br />4 Address: Co (p • 4 1 Pl./a) <br />Company: 1 � RCA p i 5 - <br />i f riMdrai. 6 1 <br />E- mc4 Y11Bl.E.AC�+tlpatt L� <br />Telephone: <br />7 & 3 T - -15 <br />-te YES <br />NO <br />/- �+! u, .. OA I <br />� /4 <br />. <br />.. <br />If sample(s) received past holding time (HT), or if insufficient HT remains to corn. <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />If NO the ACZ will contact client for further instruction. If neNher'AS' nor "ND <br />r s indicated. ACZ will proceed wON tlw requested analyses. even 0 HT Is expired. . and dote wol be qualified <br />X <br />y <br />Are samples for SDWA Compliance Monitoring? Yes U No I )< <br />lames. please include state forms. Results will be reported to PQL for Colorado. <br />• <br />Sampler's Name: Sampler's site Information <br />Quote #: .01-{' 044 - 5 - ZZ t - <br />State <br />°' <br />h- <br />o <br />U <br />o <br />( <br />Q <br />' � <br />4 <br />Zip code <br />�1� <br />Z <br />I <br />l <br />� 1- <br />, ti <br />it' <br />Time Zone <br />Project/PO #: 2 L u: 2 . o 1 <br />Reporting state for compliance testing: Co f <br />Check box if samples Include NRC licensed <br />PM w-7 <br />material? <br />14w hZ <br />3 , z c <br />6 w f <br />- 0 <br />n 13 <br />�1►� <br />?� <br />_mow <br />UPLIG• E- <br />A <br />te <br />Matrix SW (Surface Water) • GW (Ground Water) <br />Please refer to ACTS <br />�l/ir, /Ef <br />• W W (Waste Water) - OW <br />terms & conditions located <br />X 12 t� : <br />(Drinking Water) <br />on the <br />• SL (Sludge) - SO (Soil) • OL (Oil) - Other (Specify) <br />reverse side of this COC. <br />Anilim.--/- <br />F2MITA I PM iv/ <br />Er <br />/AM <br />FRMAD050.02.11.11 <br />White - Return with sample Yellow - Retain Yor your records. <br />Page 18 of 18 <br />