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Destination <br />■ <br />f , . /� . ', <br />r ,. - <br />wiffi <br />•: DD <br />Delivered By <br />Received By <br />Date Recd. <br />Recd. <br />T R d <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 25344 <br />, . _ <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 3 1 (_7 <br />Sample Date ' 1 ' !/ Time J J , / (- ) <br />Collected By I .. 4, ,jc ,.v c _� <br />Field Custodian i�_�, E f f <br />Off 5 <br />3. Field Data — Preservation: 7 e' �7 <br />t S P !', n i; ,� /. , 2 i,. .. <br />1.7- <br />Lab. No.( <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />4, <br />111,./ e(__ 2.. <br />1, ” <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: <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 />Page 35 of 38 <br />a.,uucr „ <br />- 1 e D <br />„ � <br />Delivered By <br />Received By <br />Date Recd. <br />Recd. <br />T R d <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 25344 <br />, . _ <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 3 1 (_7 <br />Sample Date ' 1 ' !/ Time J J , / (- ) <br />Collected By I .. 4, ,jc ,.v c _� <br />Field Custodian i�_�, E f f <br />Off 5 <br />3. Field Data — Preservation: 7 e' �7 <br />t S P !', n i; ,� /. , 2 i,. .. <br />1.7- <br />Lab. No.( <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />4, <br />111,./ e(__ 2.. <br />1, ” <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: <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 />Page 35 of 38 <br />