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a- Amer <br />vaW 1/i0141101I■Y <br />a04 ri�04 <br />* . . <br />_ <br />!/ <br />_ <br />r <br />Sample Loc./ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />( <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />QAC <br />Sample Submittal <br />P.O. Box 1750 S: <br />Cafion City, CO 81215 <br />A 0 0/ <br />Sample Date -7-20,/ Time ♦ : / S <br />Collected By B04 fe ..t."0 t 7 <br />Field Custodian 0 e <br />Time Recd. <br />• � 6 k P/ <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: eo �r�. <br />3. Field Data — Preservation: re-t- 9:9 <br />f /-✓ s -e o %J 1.4 s' <br />s z <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 />COMMENTS — p Explanation of noted items: 4/ e.- <br />) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />11! snarl <br />P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nncla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />�ia/P ✓� 1 C 40 /4. tart <br />e4 *OI � 4/5 , s'2 g 0 2. <br />r# 7.b t vAit 2 if? & Sdzs <br />- - -- , 4. s 1 ,4', e5 <br />) and explain below. <br />Date <br />Page 34 of 41 <br />