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Sample L ` . {ID No. . 4c1,4 # <br />Sampie. D . 5::".AiWillime . 3 0 <br />Collected By r' , , ,,,. , c ", <br />Field Custodian iL ;'A...., C , <br />Cotter Off-Site Destination <br />Delivered By <br />Received By" <br />Date Recd. <br />Time Recd. <br />S. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />t.),) <br />) Check if additional attachments. <br />t <br />Sample Submittal <br />S: • P.O: Box 1750 ,. <br />Canon City, CO 81215 <br />QAC <br />No.(s) <br />Data Entereil <br />a Entry By <br />Laboratory Destination if not Cotter: i <br />f',.• y .- Z e 4 tars <br />if <br />1 <br />c , M <br />1.. Sample Type: Air Water 7 Soil <br />Analysis Test series requested: r4' 4 to <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If. NQ, explain: <br />6. Invidating circumstances? If YES initial ( ') and e <br />COMMENTS - Explanation of noted items: <br />N: P.O. Box 700 <br />Nucla, CO 814 <br />21' 7" eeo* <br />l <br />Other (specify): <br />field Data - Preservation: / . ? j • 5 7 ti 23 en. 5 . m- <br />a'r.•+' S e 7.10 tx 0,7 s } / he 4 +r`. <br />it H 5 0+x. . ; tt.- I / 1.4004 , <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />