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L <br />PIL I IIV LVcawu ammu <br />r <br />.k <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />$5813 <br />Sample Submittal °''`_ S <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. ,c(4f e 0 S <br />Sample Date - /2-.20f/ Time <br />Collected By +- <br />Field Custodian,. /4,., - <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />• <br />Water <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: /9. 2 <br />{' '/ ifv.f ' ? /*'r' <br />} , ,: / , • <br />r7 �( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S: 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 />.vt £.. >.y. I <br />f '. <br />e.; � � {G y ,: ,r � f <br />QAC Date <br />Soil Other (specify): <br />/- . , f+`'' 2. 5 <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: / , ' ' � � <br />/7 <br />) If NO, explain: <br />