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ACZ Laboratories, Inc.erica3rA <br />2773 Downhill Drive Steamboat Spri .s, CO 80487 (800) 334 -5493 <br />Name: <br />Company: Csx,1Ch'x \Gls� <br />E -mail: <br />Name: <br />Co <br />Name: SCA(14. V-.� \S <br />Company: C- 'r>>(kto,v I CxJ` c S <br />E -mail: Sharl..._∎rl " Cp 'x.0 er\ <br />If sample(s) received past holding - time (HT), or if insufficient HT remains to complete <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />If "NO' then ACZ will contact client for further instruction If nettlter' YES' nor "NO' <br />is In fcated. ACZ will proceed wah the requested analyses even If HT 0 expired and data will be gonhhed <br />Are samples for SDWA Compliance Monitoring? <br />Des, please include state forms. Results will be re <br />po <br />Zip code Time Lone <br />Sampler's Name. <br />Quote #: <br />Pro)ect/PO #: — PAC54O — WC) <br />Reporting state for compliance testing: <br />Check box If samples include NRC licensed material? <br />FRMAD050.02.11.11 <br />o1C <br />(Yl <br />Sampler's site Information State <br />k i; o 4 C4 € i) ZtiE, <br />Telephone: W _,C ¢r) l+ 0 <br />Yes I No <br />rted to PQL for Colorado. <br />NO Li <br />SW (Surface Water) - GW (Ground Water) WW (Waste Water) • DW (Drinking Water) • SL (Sludge) • SO (Soil) OL (oil) • Other (Specify) <br />-See Qjt -e ✓ {.e_ <br />S v11kuYf m .5 <br />SoumQle-s .5 Feld - I xe& <br />'' � � m�N -' � � 51 <br />�� _ k as�e refer to ACZ s terms & cortditlons located o n the reverse side of this COC. <br />White - Retum with sample. Yellow - Retain for your records. <br />Page 34 of 34 <br />