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a.1014CL <br />vaa •vaaa a/aesaaawuvaa <br />.6.4. I"„94/4141. <br />` .2a/Ey <br />l CT6t1 <br />Vth eSC._ <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample LocJID No. . 5 6 S <br />Sample Date. Y 4-20a - Time /4 20 <br />Collected By fly 7./vw/40 <br />Field Custodian ,64 / ..v,ve <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />• COTTER SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1\12 $32:5698 <br />V- I, <br />"- <br />3. Field Data - Preservation: • 3 <br />s e cd 4,1 2 D <br />6. Invalidating .circumstances? If YES initial <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( )` NO ( <br />QAC <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />,,.. P0•5.y Z410. a 70,e r S Z.,,. �. <br />2393 Scdt Cfee/' <br />Sample Type: Air Water _ Soil Other (specify): <br />/� <br />Analysis - Test series requested: (. -mot/( 1 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />/7/ 7 6 6" . 3 4s ° ` <br />T- D s- Ala 2 S <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 />) 1f NO, explain: <br />Date <br />Page 42 of 43 <br />