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PROJ.NO. PROJECT NAME U tAIN Ut- LU5 I UDY RECORD - -- <br /> DENVER,CO.80202-2413 <br /> SAMPLERS.(Signature) r \r NO. <br /> r••� <br /> L`t OF, Y`4 i �� (1� <br /> 1 CON ���( REMARKS <br /> l TAINERS <br /> STAT.NO. DATE TIME U w STATION LOCATION �F t"1 J �� 41 <br /> t.-. ;. <br /> x h r . <br /> I' , <br /> Relinquished by:(Signature) Date lfime Received bY:(Signature) Relinquished by:(Signature) <br /> DalerTime Received by:(Signatur <br /> Relinquished by:(Signature) DaterTime Received by:(Signature) <br /> Relinquished by:(Signature) Daterrime Received b Si re Y� natu( 9 <br /> Rellnqulshed by:(Signature) DaterTime Received for Laboratory by: <br /> (Signature) Daterfime Remarks J__--rl <br /> Distribution:Original Accompanies Shipment:First Copy 10 Coordinator Field Files:Second Copy to Representative of Inspected F11 acility t !\r'I C �� M f�(( \ <br /> R8 EPA-014B (4.21-86) Split Samples: <br /> Accopled ('1 Dacltned <br /> Slgnalule <br /> n _ -) /lrro <br />