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I.-0 er <br />vii-o LO MV <br />Delivered By <br />Received By <br />Date Recd. <br />Three Recd. <br />Sample LocJID No. <br />1. <br />2. <br />5. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ,i° S 2583 <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Date 4 • 7:261 Time j y a4 <br />Collected By G4Pa..� e✓6 .� ! <br />Field Custodian IC; vet) c t <br />Sample Type: Air Water Soil Other (specify): <br />Analysis — Test series requested: ( r} <br />3. Field Data — Preservydon: <br />bo/f (7v ...T. 2.5d Al <br />/. ?'f <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. - <br />COMMENTS - Explanation of noted items: 'e1 l �P. w f` / t �. . 5 � �''"'L <br />Ti /fre:e ; 7 0 ? . j c tie( t4 tL @J <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion 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 />Nfd�� LG G f:7e+• E' . L,, <br />Z ereeA /14/y• <br />Sr Ili. r( ,, ? Z 6 O Z <br />/3.3 <br />) If NO, explain: <br />Date <br />Page 38 of 41 <br />