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L OLLCI <br />vu L4ONRa•Vu <br />/ r 'd '. -,. <br />.. <br />{Q ! <br />0 . <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />25345 S <br />Sample Submittal t . '' _ <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. _S w i 0 5 <br />Sample Date 6- /--.2c)// Time / 4 5- Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Collected By /-.?, 7.� w (- . " <br />Field Custodian / < r', ' ' -- . 2% lI <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />2. Analysis - Test series requested: r r- .o <br />�. L 2. <br />3. Field Data - Preservation: r I/ F, <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />j / Y <br />! 3 l 3 / c : t / /4, <br />i /,c/ j , ? 7 < <br />ti <br />" <br />Water / y Soil Other (specify): <br />(), S L. _ - r''' . 2 - <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 <br />Date <br />2 <br />