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1-,.,.«. <br />Off - SIte ',estimation <br />/ a � , 5 i . 0 4 7 e.. <br />�' / <br />r' <br />w <br />r, r �l <br />ll <br />3 <br />41 <br />fp <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Submittal <br />Sample Loc. /ID No. g /44_ <br />Sample Date ' .2 ?' %/ ?Time / A 5 ~ <br />Collected By /To r 4i, e t f <br />Field Custodian � 7 n <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />(r4� <br />1. Sample Type: Air Water ' Soil <br />2. Analysis — Test series requested: (' <br />3. Field Data — Preservation: ( s � � / 3 , � .. /~.. oC C ',� J oz ,„5 ,� C S <br />0 $ , 0, 6 5 <br />/ - <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 ( <br />526616 <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination <br />-f 3 /rte .i <br />! c <br />. li r VKin <br />r <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />if not Cotter: <br />J 2 C" G/ <br />f -, <br />Other (specify): <br />) 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 8 of 8 <br />