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a..OLLV1 <br />S Ina m um <br />,� .J 4 /, <br />f <br />4( , 1 <br />-- i/ S <br />��,.'/ <br />y <br />%,14 <br />1n i3 <br />5s <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />ER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ti� S ZS$ UZ <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S� - �C.7 �L Lab. No.(s) <br />Sample Date I - 9 -.20/ ? Time / 3' a S Date Data Entered <br />Collected By / T n r42,,,, a r42,,,, �I t <br />7:7„,...-7 <br />Field Custodian l - J 4 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />I.../11.011•V - De t t <br />Data Entry By <br />Laboratory Desti nation if not Cotter: <br />/ f Z <br />e Z. t- 1rar c 1L - 60' r r r f <br />� T ?7 ' t- i f �'v���i 7( <br />4,A # <br />1. Sample Type: Air Water / Soil Other (specify): <br />, / <br />2. Analysis - Test series requested: ' t <br />3. Field Data - Preservation: r -( 5 < ' 3 / // 7 7 g' {,�� / /. / 3 c) 5 4 $ 17- <br />Yin « t ' r n c s . ( 14 / 9 (. ) (•, /� ! °` T t4 "I r), V / r •"•=, !„!!f <br />)- L FA /i 4" > '2 . S r -x <br />L. <br />S ( <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 Date <br />Page 7 of 8 <br />