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l.uIw r <br />VI1 LcawlIIaIluu <br />' <br />#4 <br />• <br />IIIF <br />r C� <br />Sample Loc./ID No. 5 cci4 O 2 / <br />Sample Date 5 -20 lime /0 3 5� <br />Collected By /LA 4 / f'�✓" 4 - <br />Field. Custodian A ,� eQi✓,v' ,.- <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />* �_ 525789 <br />Sample Submittal .._ <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />3. Field Data - Preservation: TO 7 <br />54/ 2 ' <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />A G <br />1. Sample Type: Air Water I Soil <br />2. Analysis - Test series requested: de. <br />6. Invalidating circumstances? If YES initial ( <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />2373 5c14 t''er" - #cf., <br />(i. iJy 9 7C © 2- <br />Other (specify): <br /># 7 96 2/2. tss- "4- <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />COMMENTS - Explanation of noted items: <br />) If NO, explain: <br />Date <br />Patio 1 n of 2O <br />