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..UILVU O <br />Off f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. Ski s <br />Sample Date 7- ul '.2 D/./ Time / 2 <br />' S - <br />Collected By AO 4,,.- �% c <br />/ I <br />Field Custodian It", c' .i <br />D ti <br />(6 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: l , i o / <br />3. Field Data - Preservation: <br />/7 3 <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 />, 170 /2 C se r <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />525$57 <br />, G / /c 74.c/ �. <br />)) and explain below. <br />f'r <br />/1" 0 , (e <br />Date <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination / if not Cotter: <br />,tom ft✓ s' �1 [. �:h :. . G <br />/ l f c C. <br />�_f c . <br />x4-' i(4/ <br />7 2 7p 4) <br />f � 2Q <br />) If NO, explain: <br />