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•...«C1. <br />Off•Site Deshaa <br />-- on <br />Ey <br />U. <br />4 5 °. ' S (1 <br />po_o six' <br />t0' co,„... <br />3.1 `L <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :: 525770 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. sZ 1� /'L <br />Sample Date S ' 2 - 2 a o f Time /0'.2 S <br />Collected By .6 n 6 / P,,�,,✓ C.,, <br />Field Custodian /S �,:- fo ,,. c <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water <br />2. Analysis — Test series requested: ( a / <br />3. Field Data — Preservation: r o <br />F //vS e4"-J. fi t' U II w.. 5, '; e;'. S 4 A /7/./f."0 2, S : ") <br />,4 a.9s <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 ( <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />S: P.O. Box 1750 <br />N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />f f- (i Lc. „. c <br />C .c 5 4 Z <br />I G (" <br />Soil Other (specify): <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 20 of 20 <br />