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I -MIMI <br />Vaa -ola0 aJCDaaUaaavaa <br />re ,./.6 le-A.A./4 <br />9 <br />C. i — <br />it. <br />& — t. <br />• <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />S ic s <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />QAC <br />Sample Date 7- Time ) 3 D <br />Collected By (60 4: TO " <br />Field Custodian I./o c 1 1 <br />Sample Submittal <br />,:°_ s25859 <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 />• <br />PA, e,c -ce LC Ij / / u 2 <br />- 731 ) 3 Scit t t' f <br />G/.,, � � / 4/Y. Z COI <br />frJ <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested:. d L <br />3. Field Data - Presery tion: 7 I "" // . )- p / 1, Cs "y e' 3 96 4. ). S <br />rim cc e°04-,f 1i', f (..c e 7 S , d • S 4 4- / ./ ') / W<<_) / 2 S <br />5 r 40-4- / <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 - Explanation of noted items: .4, /4. ,f, 7 � �` S Z .0 f 1 . ) <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Pagc 42 of 43 <br />