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Del rered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. S 9 <br />Sample Date is - g,Aofd Time to 1 <br />Collected 'By D �€+i.sw�z' <br />Field Custodian ad 4, P .0 1 ; A'a <br />Z S 2.5136 <br />S: P.O. Box 1750 <br />Cation City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No:(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destina tion if not Cotter: <br />F A/ y LcC foe e. 5 r„. cz. <br />23`3. 548 C 'ee /Ale. <br />' S 7 . w '2 ,fa2 <br />1. Sample Air Water 2 S oil Other (specify): <br />2. Analysis - Test series requested: f i + /Q <br />3. Field Data - Preservation: f o� 0 ,• - L3 LM 7 .C� s " o <br />heAVO1 426,, L to / G 4r'>'4 /yeA 67 o <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 />COMM S - Explanation of noted items: . y f /1:4"." <br />/tee /f��f`�►�I di+e+at r /t(I+d 1 <br />{ X) Check if additional attachments. <br />' QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />) and explain below <br />w. 72 4 1 , S ' t 2. S c•. -1.. <br />Page 18 of 19 <br />a.vIaor - <br />viawia uzaWwuou <br />1 <br />/ <br />! <br />' <br />r <br />.s <br />4 <br />Del rered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. S 9 <br />Sample Date is - g,Aofd Time to 1 <br />Collected 'By D �€+i.sw�z' <br />Field Custodian ad 4, P .0 1 ; A'a <br />Z S 2.5136 <br />S: P.O. Box 1750 <br />Cation City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No:(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destina tion if not Cotter: <br />F A/ y LcC foe e. 5 r„. cz. <br />23`3. 548 C 'ee /Ale. <br />' S 7 . w '2 ,fa2 <br />1. Sample Air Water 2 S oil Other (specify): <br />2. Analysis - Test series requested: f i + /Q <br />3. Field Data - Preservation: f o� 0 ,• - L3 LM 7 .C� s " o <br />heAVO1 426,, L to / G 4r'>'4 /yeA 67 o <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 />COMM S - Explanation of noted items: . y f /1:4"." <br />/tee /f��f`�►�I di+e+at r /t(I+d 1 <br />{ X) Check if additional attachments. <br />' QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />) and explain below <br />w. 72 4 1 , S ' t 2. S c•. -1.. <br />Page 18 of 19 <br />