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• LAmer <br />464 7.e,:f <br />fr,,,„ dif4 <br />li•esaiete <br />V f . / <br />/4 <br />.. 4 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. 64 a ) PIS' Lab. No.(s) <br />Sample Date 6 - 1 --?* 0 Time 1655 Date Data Entered <br />Collected By Sib 777., e ,4,7 Data Entry By <br />Field Custodian L? Ti ..4 , Laboratory Destination if not Cotter: <br />Off-ons Dest f 0, 1.,,,. /...4„..-t,.. ,-, r.....c. <br />2 3 53 _C 6 ei 4 e k <br />'e fi 71 <br />#„,, <br />C . s 4,. , evy S Z6 0 2 <br />. / <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal tt S25828 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />• ".7- , <br />1. Sample Type: Air Water r Soil Other (specify): <br />2. Analysis — Test series requested: &i.42 <br />3. Field Data — Preservation: r° /./. 1 1.5g (7 454/1..." <br />efii:es et) 2.;57 4eS'. t " 0, 5 - 2 C4 gif/a <br />— 0 . <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 />COWEN'S — Explanation of noted items: /4... / f /2. is". <br />t 4.- 0 ,--Pe i ew. e a to 4 //re t; +V 7 <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 35 of 41 <br />