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IiVLLci <br />Vll'oILC LC61.111dIIVA <br />y " <br />y c—e— <br />/j <br />vi <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :1' S 2 5 75 7 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. S .0 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Sample Date Q -19-- 20// Time / y 3 S Date Data Entered <br />Collected By ,� c f Data Entry By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />(A/ — I <br />1. Sample Type: Air Water / (� Soil Other (specify): <br />2. Analysis — Test series requested: ( . . ( <br />Laboratory Destination if not Cotter: <br />(74 .r- Lc /00 /fir S 7 AC <br />.7 7 ? S (�. ( r r. 4 .� r <br />(_ s ,-.7 - &i /. S . ' 7(,0 Z <br />3. Field Data — Preservation: 7rc '1 7 N 7 /1 7 G " <br />e <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 36 of 38 <br />