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COTTER C PORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample 3lnbmittal _ :` 110- S"112 <br />C: P.O. Box 1750 ' -S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 812P Canon City, CO 81215 Nucla, C6`81424 <br />Sample LocJID No. M W- L Lab. No.(s) <br />Sample Date o- <br />Collected By A P <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />VVb6Cl <br />Vll'OlK 1JW6ipAiiVL <br />t� r <br />r4l <br />Fe <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1r» ri o-e Im <br />1. Sample Type: Air Water � Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - PreservationTc 10` �7'( -7-0.5 `�/� /+� 96 .15 <br />�yrn'� 1 f .�»�� -f ai. wt �/ e7 [��� % i [.' 1 �' =.►� .G <br />Of <br />JLt*A 1-1 <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 />QA Review: <br />Sample valid? YES ( <br />QAC <br />) NO ( ) If NO, explain: <br />Date <br />