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COT SON SAMPLE SUBMITTAL AND TRACKMGFORM <br />sponple Submittal <br />wk- <br />1,750 <br />9: P.O. Box 1750 <br />Canon City, CO 91215 <br />of <br />By <br />141111�-� <br />i. <br />aY <br />3. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Cotter <br />un-aw JANUMUOR <br />Iffy <br />$ample Type: Air <br />co <br />N: P.O. <br />N-- <br />t <br />Other (specify): <br />Fkid Data - PwWvadou; L. 7-& otz / 7& , 'a <br />4 Le OIL IZOE ?Zz 5 Oi"— S <br />1100 <br />ih Aft A A <br />fit, Soo. viwftgs required by (If not Holding Time): <br />4RO" handling conditlew or other hntructlow: <br />6. "I'ag minces? If YES initial and explain below. <br />uplanation of noted Items: <br />A ,3,- Check if additional aftchwents. <br />, . *"JWv6rW: <br />ftoole, valid? YES NO It NO, explain: <br />QAC Date <br />