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UI J i 1 Ic Y. uaa L /467,N.f e Fd •X • <br />V6 li <br />C: P.O. Bone ;1750 ;. . <br />CaSOn City, CO 81215 r <br />Sample LocJID No. 4/ Ye' 6 <br />Sample Date 6 °-I? 3 "2oi/ Time / D An <br />, <br />o / e°.�✓.: <br />Collected By IS .....-`J <br />Field Custodian Ad cb 1 p,,+t, es#c t <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal rz _° 5 2 5 8 5 0 <br />C <br />S: <br />P.O. Box1750 <br />Callon . ity, CO 81215 <br />Llab. No.(s) <br />1, Sample Type: Air Water (P Soil _I_ Other (specify): <br />2. Analysis - Test series requested: ! G 4 4' ,Z <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Dlate Data Entered <br />Data Entry By <br />Lpboratory Destination if not Cotter: <br />iv Ar : L. a� 4 of ex tee f . s <br />3 S-J e.A C, ' e k jYcv .. . <br />Field Data - Preservation: re • //.42_ ' � / '7 3.a' ( 8 <br />p ; 0 ! s ,,v s e re 5'27 .ScJ7 j , Drier` S. ST e r.r <br />2 L tiF ! LW/if/ c - <br />Date analysis required by (if not Holding Time): <br />£c 4# t $ <br />@ alinLs <br />2 el <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS f <br />NTS - Explanation of noted items: "S+✓ 1 v. / f/ Lr/ le ft'-re <br />4 <br />( r) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If No, explain: <br />QAC <br />Page 20 of 21. <br />