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Laboratories, Inc. L ( MO 0 7 <br />773 AorevMtDrkw Stambom i . CO 80i17 .„ 334443 <br />.. <br />., - •. ,, 3. : - . _.. C4) 8/Z • <br />IllrM AddnMc <br />• 1t• <br />T • <br />I samples► received past holding twwre (FIT), or 1f Insufficient HT remains to complete YES <br />ratlysls before axpiratlox shad ACZ proceed with request cI short HT analyses? NO <br />. 110. 10n /Ct w•••.••• d•1• wN•.• ••••0•1• •n•• ∎•'MC ••• •1Q• <br />n•,•ut.•Cj■■• - wM• •1.7r. ••b.• IR 1••.y.•• Ind ••• M•• q.1•••• <br />e samples for SOWA Compliance Monitoring? Yes No <br />f -- • se Inckde state fordo. Results MU be . • : • to VOL for Colorado. <br />d - Timm Zan* <br />• • a; <br />-- <br />..,, re ,mil <br />q <br />qs <br />III EMMEN.' <br />wrinamsa e '1I 6W in <br />MiI <br />III <br />NM <br />rwr fundedWren• OW ( OrwrMNM) WW( WadeYMmr)• DW ( DMa% Ma ra)• Wefts)•SO (stag• <br />.a. .cL 0-mj -c.e •Cad -- <br />1 <br />, <br />Piero afar b ACZ"s time i cordials ingot • , Ilia Pewee side of the COC. <br />FR1MD060.02.11.11 <br />While • Relum with sample. Yellow • ReWn for par records. <br />Page 12 of 13 <br />