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TI,OSSIVE <br />6.1 7:P ,... z' - <br />' <br />A' 4 <br />Ofr <br />iffilk*: - <br />P <br />MIL if") <br />Reed By <br />1150 <br />S: P.O. Box 1750 <br />bti, CO 81215 Caton. City, C01105 - <br />) Matt litaddionio attatbineats. <br />QA *mew: <br />QAC <br />SAMPLE suBw. <br />aifttal <br />AND TRACKING Foal.' <br />.. <br />4 • • - ..e <br />€10 A "4/40 , <br />circumstances? If YES initial ( ) and explain below. <br />— Explanation of noted items: <br />Mr <br />wooer 3 Soil <br />(7, Other (specify) <br />lognested: : <br />,':4010 <br />t ,t <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Getter: <br />-- <br />41"_‘" 0 7 la •y C ( tif I.- <br />2'! ti ; ,,fe 4 1. r <br />• hfirt..ti <br />t'f'c It/ Ze4 1 <br />Sample valid? YES ( ) ( ) If NO, explain: <br />Date <br />4, <br />Page 8 of 9 <br />• • <br />• •...4 <br />