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a <br />y J1 .3 to DV�IWRuva <br />e o4 !t'�4( 1-- <br />' <br />f.s,- 4r c y <br />/yo If <br />K3dw• <br />C.) � <br />$fie LocJID No. S S "L <br />410,1, Date/ -1 - /. Time �f3 . a a <br />ledian ct 4 f 0,,..►4.41 <br />AIR <br />COTTER CORPORATION SAMPLE _`$MITTAL AND G F <br />S: P.O. Box 1750 <br />Cason City, CO 81215 <br />fit P.©,'Box <br />Nadi, CO <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By == <br />Laboratory Destination* <br />I9tid By <br />imeillyed By <br />Date Recd. <br />AM i ltaed J <br />1. - Loomis Type: Air Water 1 Soil Other (specify): <br />2. Aeolysis — Test series requested: Tc 4 it / <br />3 . Yield Data — Preservation: t r . f 1 . Z ? f/ l .S74) r .; r: 2 (40 Ax _ 3' 4 • " <br />r e .1 7.3 0 1. , s 0 5) 6. k <br />A i <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />Islindidating circumst$nces? If YES initial ( ) and explain below. <br />NTS — Ikgidgisailoa of noted items: <br />( 3-. Omit *additional attachments. <br />QA Review: <br />Sample mod? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />