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Report to: <br />CHAIN of CUSTODY <br />ACZ Laboratories, Inc. La 6sD <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334 -5493 <br />Name: <br />Company: PV o+� �jL. <br />T S Tt39.34 CD144N40 <br />E -mail: 7 F / okb <br />Copy of Report to: <br />Name: <br />Company: <br />Invoice to: <br />� 3 <br />a <br />i <br />Quote #: <br />t <br />Name: �--. //�� <br />Company: �Ji-sT"F.(L1.11 711.LS C_.t)i.es1'A'oC7 <br />E -mail: A/ISreAcZaLS6 14.1 OP-fa <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />If "NO" then ACZ will contact client for further instruction. If neither "YES" nor "NO" <br />is Indicated, ACZ will proceed with the requested analyses, even if HT is expired, and data will be qualified. <br />Are samples for CO DW Compliance Monitoring? <br />if yes, please Include state forms. Results will be reported to PQL. <br />a'ac ist or use quo a num.er <br />• •' <br />Project/PO #: <br />Reporting state for compliance testing: <br />Are any samples NRC licensable material? Yes <br />Souri4 CoAL Chwyot <br />Mdkrtk Co /t .0 riiyod <br />sw -142.02 <br />FRMAD050.01.15.09 <br />MW )/ S rtkiLLS <br />1I <br />yc5 <br />Sampler's Name: I,»_.4 'Ry <br />J E1► <br />SAMPLE IDENTIFICATION DATE:TIME Matrix <br />12 <br />,o17 <br />102.5 <br />SiN <br />Address: 27 L 44. LA./ 61: <br />r> �- <br />Telephone: <br />E -mail: <br />Telephone: <br />Address: i'd $t.0` 62,2 <br />)JUC A. , COLOWS <br />Telephone: `j 7 v $L 1 'Z S <br />0 <br />c <br />U <br />4, <br />L <br />t1/411 A- DLttMo g 147_1 <br />.r_ <br />t�G <br />a <br />• <br />Zo <br />White - Return with sample. Yellow - ' ` tain for your records. <br />gL <br />7 S'"`1ro <br />YES <br />NO <br />1s <br />7 , <br />7. 0' <br />latrix 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 />314 <br />4 1 <br />31 <br />Page 14 of 15 <br />