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C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample L *, /ID No. 5 4. Ha Lab. No.(s) <br />Received By <br />Date Recd. <br />Time Recd. <br />lti <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ;5 <br />Sample if Time <br />Collected y '` f'Q' rtrC <br />Field Custodian 4 ,LOA- 0410 <br />Cotter Of Site Destination <br />Delivered By r <br />A11110026 1P <br />+ � <br />• Sample Type: Air Water Soil <br />▪ Analysis - Test series requested: ride. <br />Field Data - Preservation: i ... 6 5 1 7 4 ' 7 1 3 { . r_ (1,..; 3/ 1 -cc: <br />�; �. {>! x 4 -: # ' l5 6 ` '' <br />+f Date analysis required by (if not Holding Time): <br />5 . Special handling conditions or other instructions: t ` <br />6. Invalidating circumstances? If YES initial ( <br />COMMENTS - Explanation of noted items: <br />5: P.O. Box 1750 <br />Canon Clity, CO 81215 <br />(. ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES (, ) NO ( ) If NO, explain: <br />QA. <br />) and <br />i <br />N :' P.O. Box 700 <br />Nacla, CO 81420 <br />a <br />D Data Entered <br />Entry By <br />Lh atory Destination if not Cotter: <br />Other (specify): • .. <br />plain below 4 _ • . <br />