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a.11.1LVr <br />v111 IW4uvu <br />P- , <br />, il <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal �9° S 2580 f <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. Siff #4 / <br />Sample Date 6 - +' . -20a Time S s <br />Collected By . 86 P...,er c -r <br />Field Custodian. /go 774:;."0"141 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />S: P.O. Box 1750 <br />1. Sample Type: Air <br />2. Analysis - Test series requested: T # /e 1Z. <br />QAC <br />N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />4 g:# 41 a;p/ L d 40ec 40e 7 .12S TA C. <br />2 9S .S ./{f ere P ' /44, f <br />eel .0 j L!/f!" ir S 1 ' 6 1Z <br />Water. Soil Other (specify): <br />L <br />3. Field Data - Preservation: T 9. ,,..1. / 7 f" <br />r f <br />'! ✓S' ¢ e �C�1• 6. t! 5 - C.44; '0� » T't13' .2 w.- r 4/ /ifir <br />2 L 4'P , t Sv s �• <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 />( 7 ) . Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date • <br />PWfi8 ofT8 <br />