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teaa�� ��.- '. .' ,• ,. may, .. _ +a�.ww!:xa ^a *•i .- `w ..�--, .. , <br />SAMPLE SUBMITTAL AND T1tAC_4 <br />� <br />Sample Submitta� S� <br />C: P.Q. Box 1730 8: T.O. Bu 1739 N: P.O. Bob[ 700 <br />Callon City, CO 81215 C i ' City, CO $1215 eta, to i <br />Lab. No.(1) <br />Date Data Fatered <br />9 <br />Daft Rutry b <br />}4 Laboratory Destination if not Cotter: <br />•ti sy <br />_ <br />Cotter _ u ; <br />. r �t�tioa r <br />l k T"w: Air � � Soil Other (specify): <br />• <br />1040131010.1 'fit series e e ,. i ce 1 t ,- <br />`'- .. <br />Yry <br />(B' not Ioldtng Time): <br />etions or odw instructions: <br />' -i `Y `Y` - ;vim' ✓•• <br />'circumstances? If YES initial ( )and explain below. <br />J4 anation of noted itow. <br />ARM <br />7 77-777-17-77 <br />_ vaai? YES ( > no ( > If NO, explain: <br />QAC Date <br />Page 23 of 23 <br />