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T! Sample Submittal 2 3 2 8 0 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucia, CO 81424 <br />Sample Loa/ID No. /3 1r) C' .._ Lab. No.(s) <br />Sample Date .? al-) Time 16 Date Data Entered <br />Collected By Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Reed. <br />Time Recd. <br />V ULLGl _^Af <br />S f ? Vll•J1LC UCJ 1111 it L1U l1 <br />,7 <br /> <br /> <br /> <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested:! <br />s <br />/ I• <br />Soil _ <br />t ---~. <br />Other (specify): <br />3. Field Data - Preservation: .? 77 ? > ? /• 5 ? ? j ? O (-X-< rl, " <br />4. Date analysis required by (if not Holding Time): - <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC <br />Date <br />Page 38 of 43