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lAPIIACc. <br />Uri l*Ditc UMW= UIPU <br />1 7; <br />/Weir <br />( <br />/ <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />• <br />.Sample Submittal ISM <br />c: p.o. BOX 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. c141 A la Lab. No.(s) <br />Sample Date 1 Time • 2 •S-- <br />Collected By /d rivate4..,7 <br />Field Custodian ea 4 ri..40:1 <br />1110 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />• irte Jr LC 04# 4, 7 C • <br />7393. Scil eettk <br />ear/2v Ct/Y. • Rt0/ <br />Time Recd. <br />641 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: f C / <br />3. Field Data Preservation: / /1.4 7. CS ro.A.J g‘ Li rtfilt <br />t" 5 &Jail *`' O. C L r.f Iiieva 7. <br />• 4. Date analysis required by (it 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: U id / v, 4 <br />• ( • ) Check if additional atfaelunents. <br />- <br />QA Review: - <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC • Date <br />Page 32 of 39 _ <br />