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LuIwF <br />vaa -Iaaac aiw.a..�....a <br />L ..../e ' <br />/e0 ,04 <br />Pee/Le <br />-11 <br />(.. t., m <br />tQ Z' Vs.- <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. 5441 t / <br />Sample Date • & - /3-20 ! <br />Collected By Ale <br />Field Custodian I6 d 770 4 ..i t <br />Delivered By <br />Received By <br />Date -Recd. <br />Time Recd. <br />1. <br />2. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal tit S15774 <br />6. Kr- <br />Sample Type:. Air Water ✓ Soil Other (specify) : <br />Analysis — Test series requested: fa b h <br />3. Field Data — Preservation: r•-. /4 A/ 7: 7 7 e05,..6/. s ' 44, <br />rA#.S le. e4a.v4. 3. S -/ 44. z s / e rA /`/./A,03 A. u,,.," <br />/1P /.2C 'A /iWa 2:s LC/64/4 Svy <br />S: PA. Box 1750 <br />N: P.O. Box 700 <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: <br />E 44• le. or haeI "ci. tov, <br />A35 3 / 54,fr e, . Q; II( �... <br />s ._- &/v. g 2 4' a <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: - 4 H10.0 L.., r . 4 heto✓ l S Z (2. S . C••s <br />( 4) , Check if additional attachments. <br />QA Review: <br />Sam W ., valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 28 of 29 <br />