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‘,UILLVI" <br />tP11.0.1IC UVE151 <br />r , <br />,. - <br />lb A . • <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal s25865 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. e-GiAr <br />QAC <br />S: <br />Sample Date 74/ '4 Time 13 50 <br />et? <br />Collected By e <br />Field Custodian i e Al 4 •.1, <br />6. Invalidating circumstances? If YES initial ( <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />PA, <br />(.'c. • 4 ri ; • • • 5 JA. c <br />2 ?i c141 it Giec e ye. <br />( <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: (11 <br />S .. /4 <br />3. Field Data — Preservation: 6 /4.1 Z07 < <br />LK / r <br />, ...4 v • 7 c <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />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 35 of 38 <br />