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C :. P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample Loc./ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11Q S 25773 <br />1s' Z 011 Time :2s- <br />Sample Date � - - <br />Collected By 40 <br />Field Custodian 40 4 <br />Cotter Oft -Site Destination <br />Delivered By/50‘ 1 'm.'ir. Jr I .ts? <br />Received B y / 'd k' ig) <br />J <br />Date Reed. AA:. •\� �h'•2 <br />Time Recd. kc., <br />1. Sample Type: Air Water 3 / Soil Other (specify): <br />2. Analysis - Test series requested: eo G� 4r <br />. _.: <br />3.. .Field Data - Preservation: r r /a � �J 0 r ile/ 7.g 3 VY <br />rpvie <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YE <br />CO TS - Explanation of noted items: <br />tap 73 [. c <br />Check if additional attachments. <br />QA Review: <br />Samlie valid ?" ;'YES ) NO ( <br />fi.vA <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />311'54A (.7, . #yy. <br />�..1 lam/ 02662._ <br />S initial ) and explain below. _ <br />f i . <br />e." tvr I . '` j �i i •s 12. S fom, <br />7t t/Scs►, �/ <br />) If NO, explain: <br />Page 29 of 29 <br />