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Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc./ID No. ( 4.1, 0 ) 1 <br />Sample Date 717 a I I Time of/ •' 0 0 <br />Collected By , re.A. e_ 4 74 <br />Field Custodian <br />Air <br />QAC <br />Water <br />2. Analysis - Test series requested: TG le 1 <br />• <br />0.7.7 <br />s251162 <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 />I <br />.; ,) •0 •-› <br />2 ec <br />t lc> e Ekt 2 - 0 <br />e7 <br />Son Other (specify): <br />7.53 (Zi j J d_ ( <br />3. Field Data - Preservation: <br />r t (S5 ) j <br />I, , ;0 / f faitA/0. 20,J. <br />el I A" /1 'o es /C //:: / // y r <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 />( ) Check if additional attachments. • <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page 32 of 38 • <br />....L.- <br />..,..-0....,........... <br />t , <br />4, <br />Mr <br />• ....._ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc./ID No. ( 4.1, 0 ) 1 <br />Sample Date 717 a I I Time of/ •' 0 0 <br />Collected By , re.A. e_ 4 74 <br />Field Custodian <br />Air <br />QAC <br />Water <br />2. Analysis - Test series requested: TG le 1 <br />• <br />0.7.7 <br />s251162 <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 />I <br />.; ,) •0 •-› <br />2 ec <br />t lc> e Ekt 2 - 0 <br />e7 <br />Son Other (specify): <br />7.53 (Zi j J d_ ( <br />3. Field Data - Preservation: <br />r t (S5 ) j <br />I, , ;0 / f faitA/0. 20,J. <br />el I A" /1 'o es /C //:: / // y r <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 />( ) Check if additional attachments. • <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page 32 of 38 • <br />