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• <br /> COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal N 52$517 <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 Nucla, CO 81424 <br /> ,p <br /> Sample Loc./ID No. Atli< A e+ i/ We: fr1 Lab. No.(s) <br /> ,,Sample Date / ' 1 2 /r" lime / • 7 c1 Date Data Entered <br /> ; Collicted By rg,^ a', ' r. r r/C.# / Data Entry By <br /> Field-Custodian /...,41r •J t' �' <br /> � �f Laboratory Destination if not Cotter: <br /> • Cotter O[t its Destinationr / f: .rt 1, 4r, A <br /> Delivered By if tF;`Q, 2 . r, :� (r t r /r <br /> Et Received By J�' J"r f ,� e /.. i U <br /> J)ate Recd. I i‘ <br /> Time Recd. 41:7 <br /> 1. Sample Type: Air Water / 1, Soil Other(specify): <br /> 2. Analysis- Test series requested: T% 2: ci <br /> 3. Field Data-Preservation: .. 1 • 3 ¢ /-' 7. 07 ' ?6-4,9 j. 5• .? -, 5 yr <br /> T <br /> ':1R'4*� Y '� t � ) C.s. Z s"-L• it F A '' `� -., 7(1 6 <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: r_cu\(.,,C 1.1 U cC) v� i t k.1/4-1.0.4J ).e C Z.14 4 <br /> - -. � . .. ., YNm101.4.. 1. l ) <br /> ( ) Check if additional attachments. <br /> QA Review: <br /> I . Sample valid? YES ( ) NO ( ) If NO,explain: <br /> QAC Date <br /> Page 17 of 17 <br />