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COTTER CORPORATION SAMPLL.. _,,afTAL AND TRACKING FORM <br />Sample Subriliittal ,? S 2 5 21 <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. ..0C'A-1 0 ' Lab. No.(s) <br />Sample Date U ' 0 J ?IYme /3 3 5 Date Data Entered <br />Collected By Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a,u«cr vii-cur ucsunauvu <br />? .ti y'y l <br /> <br /> <br /> <br />n <br />e <br />?r <br />u <br />1. Sample Type: Air Water r MSoil Other (specify): <br />2. Analysis - Test series requested: c'?o f <br />3. Field Data - Preservation: <br />A • d (? <br />2_ ? " i .. / " (/• <br />IX <br />?r%.. <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 <br />Date <br />-image o