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Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />QAC <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc./ID No. ,$ G[/ / <br />Sample Date 1- 6 Time 9:5 5 <br />Collected By ,' l .P. —•.•r- .A 7 4-` <br />Field Custodian lSn /r''/✓ri/ c .� f <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: I g 4 1 <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S258S3 <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 />5"3 C,•e e J <br />s��. Cc/ ,' ' z‘u/ <br />/'T '7-6 G ...J 2 ! 5 4.e J` fA t c- v. <br />/(;: /{W4S .� Q.•-� <br />1 pi: != / C�/= " /l_ 46 //T .So,/ <br />3. Field Data - Preservation: r .5 <br />ate c ti(/ 3. (S 5te /4 <br />/.2 C� a / F7fic2 <br />O . , z 4/1-7/ 1 4 <br />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: -F l , L/ 6.0 �' z ) <br />) If NO, explain: <br />Date <br />Pn. '36 o f n3 <br />a.vaacr <br />via - laic aicoauaa.avu <br />o <br />r•. <br />, , li <br />/ 00 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />QAC <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc./ID No. ,$ G[/ / <br />Sample Date 1- 6 Time 9:5 5 <br />Collected By ,' l .P. —•.•r- .A 7 4-` <br />Field Custodian lSn /r''/✓ri/ c .� f <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: I g 4 1 <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S258S3 <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 />5"3 C,•e e J <br />s��. Cc/ ,' ' z‘u/ <br />/'T '7-6 G ...J 2 ! 5 4.e J` fA t c- v. <br />/(;: /{W4S .� Q.•-� <br />1 pi: != / C�/= " /l_ 46 //T .So,/ <br />3. Field Data - Preservation: r .5 <br />ate c ti(/ 3. (S 5te /4 <br />/.2 C� a / F7fic2 <br />O . , z 4/1-7/ 1 4 <br />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: -F l , L/ 6.0 �' z ) <br />) If NO, explain: <br />Date <br />Pn. '36 o f n3 <br />