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....HIV. <br />-011X Destination <br />obi <br />.. 3— (( <br />3' <br />• <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ;2S 2 5 7 6 6 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. ,j� 1 4 Lab. No.(s) <br />Sample Date S - t12 ' / Time `� 0 <br />Collected By � <� 6 I- 0 i✓�+/c <br />Field Custodian i i� . v✓G L. - <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Off <br />1. Sample Type: Air <br />2. Analysis — Test series requested: (" c7' E l <br />3. Field Data — Preserva / S <br />/ 7,7S <br />l c c % <� - �.� . ^7 . 5 . } ( -), <br />• 2 <br />y <br />QAC Date <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Water t Soil <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />, L. r O <br />Other (specify): <br />•ti..;.'. Z 7 u 5 ,/ z, f _ ✓` <br /><''%: /,' t Z <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 />Page 16 of 20 <br />