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iLI.iIL Labor at or 1 as, I nc. <br />DMW" Drive Steamboat Sprung$, CO 80487 {800} 334 -6493 <br />WM <br />CA 150 <br />8-41910- <br />Name:" IirH'4s �E -mail: Ei..'F*t%fJV- illi $iJAAf -CMOA' <br />?8-L ttt " .. n l40 <br />Name: Sac& H&rkihs Address:LM itanioniabiA u• T61�1 <br />Corn tad M, 1962XV <br />E -mail: St-41 Kt/K Telephone- e�— OS 0 <br />If sample($) received past Wkyng time (HT), or if insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />710- M. /1Ci 8-i• e.nr.eaa.nt w iwNwr xrs..tlon- x tiEr.ar 7r0- r rA..w4 8-w ree..a wpA r r.w.rd...b.....••� M NT r .M a.s WM b. �- <br />Are samples for SDWA Compliance Monitoring? Yes No <br />H yes. plows Include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name .L • Sampler'ssite IInformation State: Co Zlp code�0 g 35 Time Zone�'��- <br />Check box if observe DIMIght Savings Time 11 �C it <br />10*5100 40 A a <br />Ing state for compliance testing: C43 <br />box if samples include NRC licensed material? o <br />a <br />u ,1 117,mmi.4% 0063a <br />MCI maw SW (Surface Water) - GW (GMund Water) - WW (Waste Water)' DW (Drinking Water) • SL (Sludge)' SO {Sol)' OL (Oin Osrer(Specify) <br />�M <br />C <br />..a <br />—'" please refer to ACTS ttxrrts & conditions located on the reverse side of this COC. <br />FRMAD050.12.12.12 White - Return with sample Yellow - Retain for your records. <br />Page 17 of 18 <br />