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CorM-4,610—MMON SAMPLE SUBMITTAL TA <br />"�7 ��W' <br />4 0 wpm= <br />Somple Submittal <br />C: <br />S: P.O. Box 1750 <br />CO 81215 <br />C&fiGR City, CO 81215 -IMA&A <br />Tun <br />-.7 -ota e, <br />0PA-1 C,, T <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />,ell &� I <br />- 14, <br />--Owl <br />Type: Air <br />Water <br />2. Test min requested• <br />No <br />Sell <br />I <br />RW* Mdysis required by (if not Holding Time): <br />haadling conditions or other Instructions: <br />Other (specify): <br />dw ommuftaces? U YES initial and explain below. <br />RIPlanation of noted items: <br />Check V additional attachments. <br />QA Roview: <br />8"Wh vow. Y98 ( <br />QAC <br />NO If NO, explain: <br />"ark <br />Daft <br />