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Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2 x 25342 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 6t./ /' t E .5 Lab. No.(s) <br />Sample Date 5 / .� - /Time 0- 3 �' Date Data Entered <br />Collected By r '' - �> ti % Data Entry By <br />Field Custodian : v ' Laboratory Destination if not Cotter: <br />O Si Destina %` �• 5r �' f ', f r �. <br />/ t f i - 7 dd. <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />1. Sample Type: Air Water / Soil Other (specify): <br />n <br />2. Analysis — Test series requested: <br />3. Field Data — Preservation: ,4 6 <br />r //v F ; 1 v I_.! , 7.2 7 L., 5 e / e s <br />/- <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 />Pogo 33 of as <br />% � <br />1 <br />,.... <br />rgual <br />It <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2 x 25342 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 6t./ /' t E .5 Lab. No.(s) <br />Sample Date 5 / .� - /Time 0- 3 �' Date Data Entered <br />Collected By r '' - �> ti % Data Entry By <br />Field Custodian : v ' Laboratory Destination if not Cotter: <br />O Si Destina %` �• 5r �' f ', f r �. <br />/ t f i - 7 dd. <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />1. Sample Type: Air Water / Soil Other (specify): <br />n <br />2. Analysis — Test series requested: <br />3. Field Data — Preservation: ,4 6 <br />r //v F ; 1 v I_.! , 7.2 7 L., 5 e / e s <br />/- <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 />Pogo 33 of as <br />