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Sample Loc./ID No. <br />Sample Date 4/-/5 Time /0 . oa <br />Collected By 1?g,4 ,��.�,,�; <br />Field Custodian ge. 77.42. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S <br />Canon City, CO 81215 <br />Sample Type: Air <br />/ 1 1 14- ov <br />Water Gi Soil <br />2. Analysis - Test series requested: /r' X/2 <br />3. Field Data - Preservation: f 5 7 ,1 1 of , 6 / � <br />/� <br />u�' <br />2..5 �. S rt f r 9 y 5 63 <br />- L- /iF , / /1f4 H: c0 <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: <br />''2 525714 <br />P.O. Box 1750 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 />rr� 4 64cJr rinrie5 �N <br />A1 9 3 s4,4 ed p <br />Other (specify): <br />) and explain below. <br />( X ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 19 of 19 <br />Dessunauon <br />go ..« `r ite <br />. 7.Q. , /n/4n , <br />! L "EA- <br />Fe ,,,/6,- <br />'Ark <br />y- 15 -2,6w <br />`(-/W <br />/Ovr <br />43 f "01 <br />Sample Loc./ID No. <br />Sample Date 4/-/5 Time /0 . oa <br />Collected By 1?g,4 ,��.�,,�; <br />Field Custodian ge. 77.42. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S <br />Canon City, CO 81215 <br />Sample Type: Air <br />/ 1 1 14- ov <br />Water Gi Soil <br />2. Analysis - Test series requested: /r' X/2 <br />3. Field Data - Preservation: f 5 7 ,1 1 of , 6 / � <br />/� <br />u�' <br />2..5 �. S rt f r 9 y 5 63 <br />- L- /iF , / /1f4 H: c0 <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: <br />''2 525714 <br />P.O. Box 1750 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 />rr� 4 64cJr rinrie5 �N <br />A1 9 3 s4,4 ed p <br />Other (specify): <br />) and explain below. <br />( X ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 19 of 19 <br />