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<br />COTTER CORPORATIbN SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 2SS41 <br />C: P.O. Box 1750 Sz:.. P.O. Box 1750 N: P.O..Box 700 <br />CaAw-City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. L? J Lab. No.(s) <br />Sample D#Ae Time Date Data Entered <br />Collected By dl e ? :cnv o. -s•7 Data Entry By <br />Field Custodian /S 4'. % i?` ±f A/E V Laboratory Destination U not Cotter: <br />a.vawr vu-oue Ambu"Uuu <br /> 'r" ze <br /> .,r <br /> <br /> <br /> <br />1.. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: ' ru? <br />3. Field Data - Preservation: T ? '6 ar141 7.4 0 <br />n. f tl c4 a "`'" ' <br />45 7jr <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 />Delivered B <br />Received By <br />Date Recd. <br />Time Recd. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />6AC Date <br />