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3, <br />y <br />s <br />f, <br />0 <br />�J <br />�1 <br />AUZ Laboratories, Inc. (� fl /6 6 31,1 <br />4Narm:LA10r1 rtve Steamboat , CO 80487 (800 334 -5493 <br />V 0 Address: % CO <br />Com an : { - %- <br />E- mail: 1AU9- C,YVWei 1J- 1X,CPA4. Telephone' 1 011 <br />VK'E <br />IName-M190k j j,01 AA E-mail. .0 M &AJIM <br />-04 014 <br />Com n : t Telephone• 4 <br />Name: V &T`t-$ ftNiMLE Address: (0�2 PL,44 V VQ <br />Company: AFVCA 01 S - V5 jA%",L4mW <br />E-mailAtivn4d N/iW k30N 14 Tele one• ,7 <br />If sample(s) received past holding time (HT), or if insuffci"t-9T remains to complete <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? <br />YES <br />NO <br />If M)' thm ACZ will cantata cl ism for hethar a Vucaon ifmlthw'YES'nor WY <br />is inlKateo P.CZ �11 proceed with the requested awlyse• scan I Hr is "red, and data Mil he gWirfied Uo-,Aort ' <br />A <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name. Sampler's site Information State <br />t� <br />Zip code <br />Time Zone <br />Quote #. o1,ca -SND = 13 -s .tom T -Zak - <br />LA <br />v <br />t <br />Prgectlpo #: T 0. ) <br />4) <br />Reporting state for compliance testing: C o <br />o <br />Check box if samples include NRC licensed material? <br />°- <br />8 1 i Nt <br />-3 <br />--- <br />M SW (surface waxed cw (Gmund water)' W W (Waste water) • DW (Drinking water) ' st. (sib) SO (�) Ot. (oil) • 00W (Spet�fy) <br />1.5-5 M•6 - V W 0118014M) CPMS 4' %Ot� MI <br />Please refer to ACTS terms & conditions located on the reverse side of this COC. <br />tak) !3 1-7,- <br />FRMAD050.02.11.11 White - Return with sample. Yellow - Retain for your records. <br />Page 13 of 13 <br />