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TION SA 'LE SUBMMM4. <br />,Sample Submitial RM� <br />N: <br />Caton City, CO 81215 <br />Lab. No.(s) <br />Date Daiti ExUred <br />Data Entry <br />Laboratory <br />Air Water Soil Other (specify): <br />Test series requested: 'A' <br />wired by (if not BWd34 <br />_$Time): <br />ilks conditions or otlmw Instructions: <br />nces? H YES initial and explain,belaw. <br />of nft*&A <br />Mr, <br />F 00- <br />V. <br />d k It addiflonal aaachWo*. <br />7• YES No if NO, explain: <br />I WWI <br />QAC Date <br />Page 7 of 8 <br />V- <br />