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U :i Ulll IU IJUIIIU IIIi tlu., Vav •~~•~11 <br />IN~U~v~oRt>r~`~'ii~V~' .~. _ _ i ry.•e • ~ • , r~r <br /> <br />I.rtboreforles, Inc. <br />76400 OOwnhill DrMi <br />6fa~rtlboal 5prinae, CO 80487 <br />(970) 879.8590 • (80D) 334.5483 Name t0 Appear on Report end Invoice: oc. (R - (In lo: <br />SFCu/J ~6,^-~}"'"nl .T,e. - _ <br />y 70/1 /~ r /hct ~rn~ ~!n ~ /P ~ <br />tAa,i 1` ~• //,,, t (;,Ld uri/~ Ro s~ S - S~ 3~ <br />Attn: /l rln m lfi fr.•n n N Tel:~7o) ~)e .. yu4u Atkr, ,q o ~ .. o y e o ~-~ ~ <br /> <br /> <br /> <br />l: <br /> <br />PtaeclorP.O.N ~,~,~u,N mac. ANALY SES REQU ESTE D <br />S'~COR ~ru,~t ~ /Jvn~-003-0/ ~ <br />a ; <br />h ~ <br />~v REMARKS <br />iA4pped VIo: FED X_ UPS_Hand_01her $ ~' <br />~ 2 ~' <br />~ <br />SAMPLE IDENTIFICATION LATE TIME ~°. ~ ~ ~~`• ~ ~ <br />W- 3• S y 0 6~ 7v r ~- - N a~~n e <br />w- - 3, 0 6 S v 1 ac.~ <br />hw- - 6 , vv r <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />• uwi.Opuw $W ISum4 N71M) • OW (Or01C14 wally) • WW {Wutr,wala4 • ow (Orintkp wales) • SL (Sludges) • SOIL • Del • DNer (Speclfyt COMMENTS <br />SAMPLE DISPOSAL 0PT1ONS -please complete eecllon A, or chcors ms nprbn /rom eecllone BAND C. <br />PjOpI/ C1y1IpM IYlll tsa aaNlaad• nP/ 6~ o ~e ~ ~S ~/`/S <br />!N Lono-term alaape <br />iotd unltl (date) <br />iv Mules anelyeie. (BJ fl Semple 1s Hnn•Huardau~ <br />f) Lacal Dieposal <br />2) flCRA - Parmlltad Facilely <br />J~(ZtllW 11\V Vtry.ii (C) h Sample le Ha:erdoua <br />1) fiGliA-Pelmined Facil(ly <br />2) Relum to CIIeM <br />~ELIN4Ui HED Y: SIGNATUR E) DATE TIME RECEIVED 8Y: (SI GNATURE) DATE TIME PAGE N <br /> ~ l6/U r ~ ta- 3~ a4/rf' G i 3 --~- <br /> - ~ ~, OF <br /> <br />yyryp ~ Hlfurn w/ lJmpll renaw ~ n~rurn w, sunprc ruin ~ ,rearm wi as rnpil <br />uom ~ neap mr yaw ucorae <br />