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ACZ Laboratories, Inc, <br />2773 Downhill Drive Steamboat Springs. CO 80487 (800) 334.5493 <br />Name: KG rWle vi 14 h <br />(c.c. <br />HT remains <br />short <br />ACZ eel proceed <br />Address: I CO33L fa l& <br />Company: Cr vw y it ww S <br />LC e. <br />-1) OX • 4. <br />C d ✓ ? rd 8 g - / <br />E -mail: /( g is/15 p / <br />Telephone: ''70 • S&' . Da 7, <br />, <br />Name: tKe V' Ov m/ s <br />E -mail: t4 yi Oi"VLS p is t, oo , Cc; 0-1 <br />Company: 1149 VvI N to i.v1s Co . <br />Telephone: 0 17 Q - L a 4, -- a S'55 <br />Name: t'e-.e in 0 vVf S <br />Address: -It 6 U 5 V4t4 "/ S5-0 <br />Company: Tk W1 w1tv.S <br />P'Id5c,3ex <br />1 CQ cis 1143 <br />9 7 D - [9 a Lo "' a n <br />E -mail: K vl DY1/ t S e l ra 1n ors . C • <br />Telephone: <br />If sample(s) received past holding time (HT), or if insufficient <br />analysis before expiration, shall ACZ proceed with requested <br />If 'NO' then A( Z wrll contact client fee ftrthaf ■nstfucuon If neither YES' nor' NO Is Indicated <br />a raIyses even If HT Is exerted and deta will be quehfied <br />to complete YES <br />HT analyses? _ NO <br />nth 'he requesb•d <br />1./ <br />Are samples for SDWA Compliance Monitoring? Yes <br />If'yes, please include state forms. Results will be reported to PQL for Colorado. <br />No L J <br />Sampler's Name: I < 141vi <br />0 <br />w <br />o <br />Zip code <br />(� <br />g)w <br />a <br />/ <br />Time Zone <br />�• <br />PY/5T <br />u 1 <br />Quote #: C)yYlS V)W1 <br />Project/PO #: <br />Reporting state for compliance testin C (7 <br />samples NRC licensabl <br />Are arty p <br />twYTT – CD S - 00 1 <br />material? Yes <br />D7 tta41.7 Vi-DO <br />o � <br />c5w <br />1 -C J? s - -pea <br />D /,Doha R' <br />5tA) <br />,Vw <br />Matrix / ®F, urface Water) , GW (Ground Water) - WW (Waste Water) • DW (Drinking Water) • SL (Sludge) - SO (Soil) • OL (01) • Othe (Specih ) <br />Ii <br />2 e.. d l •e 5-e n 1-- <br />on -e- 6of_ vwlpCP ccr <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />Iiii <br />AIM <br />4/IIWIFIFIWAIIIIMP <br />FRMAD050.02.17.10 <br />White - Retum with sample. Yellow - RetaM for your records. <br />Page 35 of 54 <br />