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LULLC" <br />V1L 1IV LIca uuaaavu <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />S f -2'0(i f ro. 3 <br />Sample Date Time <br />Collected By 4,4 <br />Field Custodian f 04 T A—ai <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Water Soil <br />2. Analysis — Test series requested: d <br />r.. �. <br />3. Field Data — Presery tion: V <br />7f47 g , c ' , s <br />: __ 0.5 i / // /U ' <br />6, <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1:2 S 2 5778 <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 />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not. Cotter: <br />2.. 3 53 .S .�t' r' /.;', <br />y r, <br />C' - : s1 ,' 4 J Y: s' t) 2 <br />Other (specify): <br />) and explain below. <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />� ,esseir7.” <br />rage 38 of 44 <br />