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L.uaas;E <br />vaavak a messusau a <br />dad t :1As4t4f <br />• <br />fneku <br />p C <br />1o39.5 <br />Re :5 G:.04 <br />corms CORORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal NS Amiss <br />C: p.0.111=1750 S: P.O. Boar 1750 N: P.O. Box 700 <br />Calk* City, CO 81215 Cation City, CO 81215 Nada,.CO 81424 <br />Sample.LocJJD N.. S t i 0 S Lab. No.(s) <br />Sample Date - 57 /2- Time b .' 3 J <br />CgUected By /.3o 4 To, rte �t <br />Field Custodian 4 I n n 6 4 1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />in Qs, s y 40,.-4 4 Ire, c <br />23 Solt Crc t'4' ,h/w 5,, • <br />icte• 4.1Y ?zCvi. <br />f 'Gn <br />1. Sasapte Type: Air Water I Soil Other (specify): <br />2. Analysis - Test series requested: f JQ <br />3. Field Data - Preservation: re. 742 '7 (% /. "We 1_r <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 />COMMliNTS - Explanation of noted items: <br />( ) Check if additional- attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />...; :.:,. • : s. <br />QAC Date <br />Page 39 of 42 <br />