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L.oucr <br />- e ',Mai/Magill/1J <br />, b TT,.rr� L <br />W • <br />C( r <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2 8 555 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc. /ID No. S� g DIS Lab. No.(s) <br />Sample Date 7-4-.2 Time P.'S <br />Collected By _ s 1. ,�,.s �- r <br />Field Custodian r ., E. T "✓� ` T <br />off s <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />I. <br />Time Recd. <br />4p L. <br />1. Sample Type: Air Water Other (specify): <br />2. Analysis - Test series requested: (..0 Jc <br />3. Field Data - Preservation: T / 6 .(t., H 7 / 1 � 7 / L/ /rte ! �. / /` z S <br />e l� rl nv / 57 C . I yy` ,r! S r[. � J ( . 5 • . /f[/ f �. , 9 2 . 5 <br />Vic_ 4z D. G P, ' <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 -- ENTS Explanation of noted items: '�i edf, t tiF / , 1/ 0 r <br />` <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Pago 38 of 13 <br />