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I.VLLLC V <br />Vilna/11C IFt %IUMMIUU <br />1104 �PivAlicA , <br />,red .), <br />fed <br />44 T• t 5 <br />5 +-f tu- <br />t trcr0 V <br />VeA. t.)1/4 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample LocJID No. <br />Delivered By <br />Received By . <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal � � s25694 <br />ors Lab. No.(s) <br />Sample Date L i' 6 '2 Time J). . !4 <br />- Collected By Ris lO. /../a t <br />Field Custodian i 9h vA r i.' ,— <br />Time Recd. <br />U f <br />• <br />a <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis Test series requested: code <br />3. Field Data - Preservation: T mc. . 3 y J / 1 . 60 cf../ u M*� <br />/ . 24 6 S - <br />t f.v s e o • , . c f 3.2/ ra S 4.1 3 - 4. S- t l <br />Sri O.7/ <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 <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: ter: y^ <br />14 ho.9 a I /BPS .LN <br />- z3 73 S Creek ff <br />ce ��� £ /y. S Z 6 07.. <br />--- -Page8"43 <br />