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1. M' <br />- <br />�, <br />(d�. QS/nn A.l <br />S (2 -ll <br />/� C7� <br />e' <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal + � S 2 57 $ I <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 1''i' 03 Lab. No.(s) <br />Sample Date C ' /0 - 2a(V Time / 3 3° Date Data Entered <br />Collected By f d:4 6 7�='.•f•✓ c ✓ 7 Data Entry By <br />Field Custodian /'E,ly jO�.A/ C. Laboratory Destination if not Cotter: <br />A O f f Site Dest p L c , 4"2, 7 ' ' . -3 C- <br />2353 ,f S ej ei, 40 10 , / <br />c ,.■ 1 G . " Z 6 oz. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />rr N <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: (77 cP e <br />3. Field Data - Preservation: 7 7 c 4 / 1, <br />ti <br />1.19 <br />> / 4 /2,O) Z$" G 5a <s <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 41 of 44 <br />