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1 1.l)LLCI <br />V1l..4mm IJV IIJI ILIVu <br />0..0 <br />7# 4 tie r <br />t � !' t - <br />/- 42 <br />r , Mii- <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 2 S 25340 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc. /ID No. ((-" A Lc/ .0 Lab. No.(s) <br />Sample Date 5-- ✓ / ...L)// Time O 3 S Date Data Entered <br />Collected By ' .v sr/ .s t Data Entry By <br />Field Custodian CS,: C 7 . -v .L/G f Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water / Soil <br />2. Analysis — Test series requested: ( rP <br />3. Field Data — Preservation: <br />T 6, '7 <br />5 .x> ? / <br />11, . � � U, , ? . ... <br />2 2`j 6 .`- ek /f�- j. <br />A <br />77e) 2 <2 , '> ,,,/ <br />G.5 fir /1 //.47 ": r , S <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: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Other (specify): <br />0 / /Do•a/ /7 <br />egc <br />