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OZ 10 6 L abed <br /> COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal s <br /> 21656 <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. SW /./L Lab.No.(s) <br /> Sample Date Z " ' 0/6 Time Jd 3 d Date Data Entered <br /> Collected By QG T A'il,sr G r' Data Entry By <br /> Field Custodian S46 TPNH4i f" Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination n �; y Zc 6 -4 f > 7-- <br /> Delivered <br /> Delivered By g)1 " Cali Z 3 c :1 S€ >, <br /> Received By `F } e, +, Cels 51J P� lc/ y. <�' t; / <br /> Date Recd. 2/'if ft <br /> Time Recd. Z <br /> 1. Sample Type: Air Water�5� Soil Other (specify): <br /> 2. Analysis- Test series requested: /d C /co <br /> 3. Field Data-Preservation: TY— 4' ' 6 i## 710 .3?o S ay' c -cc <br /> r.17 c �-t, J. 3. 434. -(w s `c 6. 2 5-4 g sf/tea s t r y <br /> / G C/" /1 /-//✓ U3 2 U,....,.J, O. 7 5 4 U/` 0. cL liTA A/ 50 <br /> 5�L ./:"A/Va OA/ 2 5 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 ( ) NO ( ) If NO,explain: <br /> QAC Date <br />