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C: P.O. Box 1750 S: P.O. Box 1750 <br />Cafion City, CO 81215 Cafion City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date 6 - 3 0- 2- 0 // Time ! i • 2 0 <br />Collected By JO 4 'Q "in./ ti <br />Field Custodian O 4, 7 "le Af tat <br />Delivered By 6'06 <br />Received By �� <br />Date Recd r /// <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Cotter <br />eel/A& <br />Sample Submittal <br />Off -Site Destination <br />:;2 s25825 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory y atory Destination if nogCit er; <br />e C'sQ LGG f � 0 rG TOvr �'S ti <br />.t. <br />/ fed &` 2 3 93 cal C v e <br />zNe r ) g24/9 I <br />Time Recd. /0 :) r <br />1. Sample Type: Air // <br />2. Analysis - Tesoeries requested: ! ; b /Q 2 <br />3. Field Data - Preservation: 7 -4] 12.4 !1 ' 7.1c) iv <br />6' C/ s 3 8 Gcsai 2 <br />n. <br />r <br />4, <br />Water b 6^ Soil Other (specify): <br />°` prie 7. 3.Z <br />/ /,It',UD 2 / tr // -/f ///f/D 2 <br />7 L Li/' , / L Gf - Al /91 co <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 ( <br />COMMENTS - Explanation of noted items: r J 74-, <br />/fed/ G Pe C.� } u Il tt t/ <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />; 7 1 1 V A A ? s, 2e /2,S c•K <br />J. <br />4 (1501100 <br />Page 21 of 21 <br />