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COTTER. CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sts64 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Submittal <br />Sample Loc./ID No. S ttiA 00 <br />Sample Date y 6` 2 oil Time 9 57S <br />Collected By g D 6 f <br />Field Custodian eb v..r�✓ -... <br />Cotter Off -Site Destination <br />Delivered By ��-- ' t ,, _ <br />Received By / :P J1 E <br />Date Recd. Vt. (ti <br />Time Recd. •O <br />6. ' Invalidating circumstances? If YES initial ( <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />fiLD Er <br />Lab. No.(s) <br />Date Data Entere <br />Data Entry By <br />Laboratory Deitinatlon if not Cotter: <br />or et !o ` /w3 <br />,qG4/y. <br />�G . +�►r [J y. O 2 6 0 2_ <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: ( l <br />a <br />3. 'Field Data - Preservation: r 7,9 i ° F 7. 4 7 &„,„e 2 4($ <br />/'�.•• s a C e.�sd. 1. 5 7 � " s -z 7 ° ` U. 5' G- G171 41 Q s 2 <br />) If NO, explain: <br />) and explain below. <br />QAC Date <br />. :(Y Roil7 <br />Nitiii4 CO 81424 <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />