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{.VLLCE <br />./1.VM a ucea■WI Iavu <br />I ,6 ZP,,w, /c v / <br />! 2 <br />0 <br />Sample Loc./ID No. <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Caiion City, CO 81215 <br />Sample Date S " '23 2 / Time . /0 2 S <br />Collected By / Tt^:r✓n�c ^� <br />Field Custodian dd 1 0"./.1/Q ! <br />Delivered By <br />Received By <br />Date Recd. <br />Time <br />Recd. <br />1. <br />2. <br />e <br />3. Fi id D t <br />rIAl <br />sr.( <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM ' . <br />Sample Submittal 1 � 7 8 <br />• T__l•_ l• <br />Preservation: T 7 3 // <br />/t/7 <br />6. Invalidating circumstances? If YES initial ( <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destinati if not ( Cotter: <br />ivPi G..y� � <br />e. <br />lj.0 C / lli� ✓5 ��.�i <br />3 33 /f ..S 17 .. ef' P <br />< ��.. iii'!! S z c o z . <br />Sample Type: Air Water l Soil Other (specify): <br />Analysis - Test series requested: &o -gyp <br />a a- <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <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 />el /OsOg3 <br />Ns $ d E Ox 700 <br />Nucla CO 81424 <br />6 <br />) and explain below. <br />Page 13 of 20 <br />