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t.u«er <br />Wir Yca.aaaa.a..a <br />T, <br />» - <br />rr <br />MI <br />I' � <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .: _ . S 25346 <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. <br />Sample Date ( ' / 2 u' / Time ( 7 5 T S - Date Data Entered <br />Collected By / ., '2 7 oA_'yG 2 Data Entry By <br />Field Custodian / • - " � `-) / " ' �' /✓G <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />(-C/ C-- S <br />_A <br />Water 1 Soil <br />"J <br />2. Analysis — Test series requested: f :i.' c r <br />3. Field Data — Preservation: ��� V t` ' 0 7 f 4-/e, Z �' 6 5 . c.. I <br />ri s ,.. 7& r. 7 t ` - % ;1 . L 1: - ,41 i Y/ ?,/ 7, S <br />Lab. No.(s) <br />Laboratory Destination if not Cotter: <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 />(//ao/77 <br />Page -37 of 38 <br />