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I.ULLCL <br />J11.011C L V IIUaLavu <br />v 4 4 °,1.40"‹.ti A <br />/ • <br />-- <br />• <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ? s2505& <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. W'�- <br />Sample Date 7 - ',2 // Time // S $ <br />Collected By ' ra ,., , A.:7 <br />1- <br />Field Custodian/ • 7,,4, et/0 et. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water �/ Soil Other (specify): <br />2. Analysis - Test series requested: (1- t: t <br />3. Field Data - Preservation: % v"- /6. b 44 , /1 7.81 175 <br />G' 5 4 7 <br />r-/rt s Q / 3.7 U X 61 e) 5 C /` "r 11/U'y <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />and explain below. <br />CO ENTS - Explanation of noted item: <br />.. u � �" ' f + - ' , i $ ` Z '' 71 . <br />f } J <br />! <br />6. Invalidating circumstances? If YES i al ( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />e.. L.G e.ii G �, s S <br />7 7 $ .S S �:. '- C i -k t /t40 <br />t ..� L1 % . C ZC <_)1 <br />� <br />) If NO, explain: <br />Date <br />f <br />