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<br /> <br />r !" eBTTER CORPORATbN *AMPLE SUBMITTAL AND TRACKING FORM <br />Sample Sub <br />attal :`; S 2551-4-8 <br />Tr r. °- <br />C: P.O. x 1,150 ""BM.- P.O. Box 1750 N:. P.O. Box 700 <br />CaS Clty, CO 81215 A Canon City, CO 81215 Nucla, CO 81424 <br />ty <br />Sample. LOC./ID <br />No. Lab. No.(s) <br />Sample D*te I -Ir/"?'...f `'Title 9.' ? Date Data Entered <br />Delivered B <br />Received By <br />Date Aecd. <br />Time Recd. <br />Collected By >> Data Entry By <br />Field Custodian ?+?.,.,.r ' Laboratory Destination if not Cotter: <br />' C tt <br />U er Off-Site Destination <br /> <br /> <br />'a <br />e <br />ample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: • r r:. ?? .. a t <br />4. Date analysis required by (if not Holding Time): _ <br />5. Special handling conditions or other instructions: <br />r <br /> <br />6. Invalidating circumstances? If YES initial ( ) and explain below. _ <br />COMMENTS - Explanation of noted items: <br />----------------- <br />