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r SAMPLE SUBMITTAL <br />Sample SWbmIttal <br />Z.00 Box 1750 S: P.O. Box 1750 N:* <br />C*&*R City, CO 81215 mim� ftimu <br />CMAOK City, CO 81215 <br />No- -,06t1 A -,/.I ff Lab. No.(s) <br />&Z <br />TIMM i <br />0e) Do* 10aws"I"W <br />Data Entry fly <br />Laboratory Peg <br />rwo MIA- ­77 <br />0, <br />7? <br />r4 S 09 Ir <br />�w. Air — W&W-Z-� 'Soil Odwr (specify): <br />•'Twt series requested: <br />- A, <br />—Preservation: <br />T1 <br />.7 <br />4v <br />v <br />7F <br />10 <br />by (if not 10jAdliag TAvW: <br />or ad <br />W instructions: <br />1xvircumstances? If YES Initial and explain bd".* <br />of noted ftmos: <br />�WITMWI- <br />�Mple v � W? YES NO <br />QAC <br />If NO, explain: <br />Date <br />Page 25 of 25 <br />Ak <br />