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_ u«GI <br />.III IIC Lc3111144 LEV <br />45 ot 1,O A/C -.., <br />/ , % : t om <br />� � ' <br />/VA— <br />AMIE <br />lift <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. c 1A) Us <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2s 25755 <br />Sample Date y' / 9 2 (Y/ Time / 3 OS <br />Collected By )3 n 6 �,�.✓r <br />Field Custodian Xe ) Z 1� �✓ .T. 1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: e'" : / e. <br />3. Field Data - Preservation: / .' 'Y 5 ? . 0 5 - / f � -t/f. -t/f. 2 5 7 u S 4,1 s ° <br />r e eo-ve, /. So a ..7z. S ° ` 0 , `7 / ' . '1 / //' , 1 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 ( ) 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.Box1750 N: P.O.Box700 <br />Canon 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 />./ 1 iI G 4 a... / / / P t i L /�i <br />Date <br />Page 34 of 38 <br />