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_UtiCU <br />a es <br />1a 4 I °� 4J <br />/ <br />, p e4 Y <br />I • <br />�1yy <br />`7 <br />as <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />2 <br />Sample Submittal 525792 <br />:.Y ' <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No.. 5 Lab. No.(s) <br />Sample Date S 3 - Or/ Time / 3 4 5 <br />Collected By /g `'� <br />Field Custodian �': k a c. 1• <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Off Sit D tinat <br />2. Analysis - Test series requested: <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1. 313 S'€ZJ c '° r P //cc, �. <br />, c) Z I, <br />1. Sample Type: Air Water l Soil Other (specify): <br />7 o f /� 4 7- 2 5 ,rr/. 2 / �. 1.< . a s ._ <br />3. Field Data — Preservation: !' <br />t /4:s•t" A, Z,b g 4. s 1� ,y � y P. 2 r <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 />P ^go 17 of 2C <br />