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-s <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM - <br />t<to c9?U <br />Sample Submittal ??- <br />P.O? 1750 S: PO. Box 1750 N:' P.O. Box 700. <br />Canon <br />C: Box City, , ' CO 81215 Caflon City, CO 81215 Nucla, CO 81424 Sample Loc.llD No. J•?- <br /> <br />Sample Date Time d : G <br />Collected By <br />FieldCustodlsn <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination If not Cotter: <br />41; 0 <br />50 <br />'-'k 1" .0 f' <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested:. s? <br />.. .y? 7 ? . -S ? f • 4 <br />3. Field Data - Preservation: ' r <br />ow 0%e 2- OZ141CA-1, <br />4. Date analysis required by (if not Holding Tiime). <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial l ) and explain below. <br />COUNTS - Explanation of noted items: <br />( ) Check u additional attachments. <br />-? _. ------- --- - - -Page 39 0, -f39? <br />