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%.VLLCI <br />JLL�47LK 101:11141016001 <br />ITS <br />4-7 •t1 • <br />• Z%.1' 10- <br />icrcr0 <br />tL . <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 3 s256-97 <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 <br />Sample LocJID No. S 41 L 0 <br />Sample Date y -6-20// Time /2 1 149 <br />Collected By 13 <br />Field Custodian /LC .v •� ..� <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: t <br />Ze ? 7 S . 3 d � IT s 4' P ` ' f T 4 a ' / . <br />(''4 s �.., l % _ Z e 2. <br />448A/ <br />1. Sample Type: Air Water / (e Soil Other (specify): <br />2. Analysis - Test series requested: . <br />3. Field Data - Preservation: P it- o / 7 ea ()—d z ' 1 Let 4 - 0 (" <br />r/A z.2 S A s a i. l � S/ J ..01 f'4.I7 Z. S 7 <br />. /- 5 -/ <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 ( <br />) 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 />Date <br />Page 41 of 43 <br />