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Name: gut. N DAy <br />% e -s <br />HT remains <br />short <br />ed. <br />Address: ( 4 Wit ow Ei bnx_ t d .3• <br />Company: 4 ER_ Assoc., A / <br />EKE w,,. Q, c,0 tOZ1 <br />E -mail: kDA n i s a G cm. p r c.e4I <br />_ <br />, Telephone: 30 3• q aa-oS4 o <br />Name: 544 WAIL- K f N S <br />E -mail: SH0.A-4sf E V ' • C.M <br />Company: 4 b4.DE'R AS$ o-c4 4 're <br />!. <br />Telephone: <br />Name: A o J $ We—a VIoM(,E <br />Address: SAS 'i!. 4o <br />Company: 6:t9LDa licsailk4 4 C) <br />= <br />E-mail: <br />Telephone: 3o '3 q 8o - oS 4 o <br />to <br />_. <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 ACZ will contact client for further instruction If neither - YES . nor <br />is indicated. ACZ will proceed with the requested analyses, even if HT 5 expired and data will <br />to complete YES <br />HT analyses? NO <br />Are samples for SDWA Compliance Monitoring? Yes u No <br />If yes, please include state forms. Results will be reported _ for Colorado. <br />Sampler•s Name: If t , / e .PAlies • <br />Sampler's site InformaUC <br />State <br />o <br />U <br />o <br />4 <br />8 11_ M � -r4 olos lc <br />Zip code <br />Time Zone <br />40 T <br />— <br />Quote #: HOG- Ct'4. <br />Project/PO #: 10 <br />Reporting state for compliance testi GO <br />Check box If samples Include NRC li censed <br />' —1 <br />material? <br />, �firr <br />o lFlr <br />O� t it. <br />on. sot :So <br />Cu' <br />ty Z <br />1 O:4.O <br />rw <br />Cu <br />Cw <br />CV- <br />CU, <br />et <br />4 <br />i f <br />41 <br />if <br />r <br />v <br />✓ <br />/ <br />— <br />—„ <br />_.. <br />M vt1 3 <br />O!/ttfrg VVISO <br />oil( . 141ig <br />alil)Jt2. (i:oo <br />0f /131t IT to <br />Mw .' tfi <br />AtN ... 9`l <br />MIN — 33 <br />• <br />Matrix SW (Surface Water) • GW (Ground Water) <br />Please refer to ACTs <br />I/4 K a ' th <br />• WW (Waste Water) • DW <br />terms & conditions located <br />t is <br />(Drinking Water) • St. (Sludge) • SO (Sod) - OL (OiI) <br />on the reverse side of this COC. <br />€ <br />- Other (Specify) <br />-- <br />ACZ Laboratories, Inc. C <br />2773 Downhill Drive Steamboat S , CO 80487 (800) 334 -5 <br />FRMAD050.02.11.11 <br />(ola:5 <br />White - Retum with sample. Yellow - Retain for your records. <br />Page 40 of 40 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />