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OZ 40 8 L abed <br /> COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal N° s 28653 <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 /> Sample Loc./ID No. SG-, A w f) Lab. No.(s) <br /> Sample Date 2 - S -20/6 Time 91 / $ Date Data Entered <br /> Collected By ejp d I Pdl/l4,1 t Data Entry By <br /> Field Custodian _4.4 tP.4 or 4 A t Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination y6 ao �� r s <br /> Delivered By a04 I y 7. 193 S fr �Qt �C //.,��► <br /> Received By ���/1�' �• s� Pr C41_, O 2 6 0l <br /> Date Recd. Zrn l f C <br /> Time Recd. 1 t- <br /> - V�.Nli <br /> L <br /> 1. Sample Type: Air WaterS Soil Other (specify): <br /> 2. Analysis- Test series requested: 7.;- 4 1 <br /> 3. Field Data -Preservation: roe 2• `, 7.07 (.,L-'J Z ,p s 0L <br /> YL.►r I C 165-.1, S 41, 4. Z s-4 F l L� !� �; /!iv03 <br /> O. 2. L ie f# a . S- Le 1A /-1 .S'��11 ti Z . S .F <br /> cti S L uf // Nc// 7 . 5 <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 ( ) NO ( ) If NO, explain: <br /> QAC Date <br />