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‘..VUCI <br />vii -alLC &,v imaiiui <br />i4) <br />A <br />F� , E <br />/ T ` �4 <br />POD i <br />/ <br />1 <br />11/20// <br />- <br />Y GA-- <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i a S 25752 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. L},4 O O t <br />Sample Date I I - 0// Time / 0 S � Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Collected By /3 0 <br />Field Custodian rfo ;J Tc'.v /, ,c. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />7- <br />2. Analysis — Test series requested: r; 1 4 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />F A- y Lc Z dYa 1/J ✓1PS J / ...• < . <br />r � J7 ` ` C -toes' He4/1/ <br />Water 7 Soil Other (specify): <br />3. Field Data — Preservation: T a S q c' ,Z S -7 5 G z y 4 6/ 9 <br />ri.v s o i.9 az .c,/-, s .. z. f� /. I/ 2' ,/ l' t=,A 4 2 0,fi <br />a. 5 L 1.//',4 //1 G c . I <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 />QAC Date <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 />Page 31 of 38 <br />