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%.,%/14101 <br />1.111 UVOI,IMILIMI <br />. ' <br />*.■ <br />• ,. <br />. <br />I.' <br />Si <br />larAiAtt <br />111112, 4.4_ i <br />9 b <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. 41 / <br />Sample Date 7 0 <br />Collected By <br />:Field Custodian 4: <br />Delivered By <br />Received By <br />: Date Recd. <br />Time Recd. <br />Sample Submittal <br />S 251181 <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />1. Sample Type: Mr Water Soil Other (specify): <br />„.-"" <br />2. Analysis - Test series requested: ( cd <br />6. Invalidating circumstances? <br />COMMENTS - Explanation of noted <br />QAC <br />If YES initial ( <br />items: <br />1 $ <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 />3. Field Data - Preservation: T, ./ ill' - 7. 76 i 2 <br />J .5' ; z e, <br />2.3 a <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />