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...,....V. <br />- NIC C0I,ua.IUu <br />� .�rr 4 t4 .4!✓C:, <br />f•'. <br />4 � <br />MA1 J <br />II <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM ' s 25765 <br />Sample Submittal t + <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />C 4' <br />Sample Loc./ID No. - t' DJ S Lab. No.(s) <br />Sample Date x"-02 2 v 6 • <br />Time 9 S <br />Collected By iJ r.'43 / ��.•� �.-� � .� { <br />Field Custodian . :F <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Off S D <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />7 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotte <br />( r a 1 v QC <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: C F 3 c 4 <br />3. Field Data -- Preservation: <br />_c } " <br />f�vS'e Z. SF7 ! r .� ? s ' tar S G ft.-4 ,:f 2..5 ,..,�•., <br />P: <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 15 of 20 <br />