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%,OTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal- X2 S M j <br />' ` T <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 J Nucla, CO 81424 <br />Sample LocJID No. ..W/ � � .. �o, PL Lab. No.(s) <br />Sample Date ` ' " 'S--2 'D cime <br />Collected By <br />Field Custodian i' , �' $< • �'►�� ? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />V V�LOl <br />V11101M Wcounnuum <br />ex <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cot�r: <br />%'ipfr l �bt CA.' .:f 1 MC <br />}+ i i C r f-c r. H w <br />..�` �I;; we P2601 <br />i v <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: • ! f� 4 "' <br />3. Field Data -Preservation: % �} - f -la E{.Dyr <br />ir <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial { ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( } Check if additional attachments. <br />i <br />QA Review: <br />Sample valid? YES ( } NO ( ) If NO, explain: <br />A* <br />QAC Date <br />i <br />Page 27 of 27 <br />