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%.ULLCY <br />Vll'AIIO Ircaussa VI1 <br />/2 i , wG ', t• <br />;`7L.1- £, - <br />--CCT <br />r4a i <br />/s I <br />/�/ <br />�G Y G <br />if* <br />9: if Ye/L <br />i/gr <br />y <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :, 25751 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. tf/ A G/ /) Lab. No.(s) <br />Sample Date q /`7 0 f Time / 0 S O <br />Collected By /IS <br />Field Custodian L. ? <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />/4“‘" <br />l , <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: (' •eJQ <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />P.r e" y Lc `.� a... 4 / � } .i / n � , L . r <br />Lt/ %: 2 O Z <br />3. Field Data - Preservation: 7-u, S! 9 7 -2 C . / 3 c <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 />Page 30 of 38 <br />