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CA) IMF <br />vlI -oIIt 1,v uHSU <br />a.. <br />a <br />/ iO / % <br />Fe 'CA- <br />fed for Gc6 <br />1 / 1'b <br />ltf1 _e----^ - , <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Sample Loc./ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 25873 <br />Callon City, CO 81215 <br />MA/ <br />Sample Date $' 4 Time ? <br />Collected By 40 b TQ.A" sr .,.4 <br />Field Custodian A e 4 re n".g <br />N: P.O.Box700 <br />Canon City, CO 81215 Nncla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />kle +6, a� a cry � s <br />a �. <br />S'3 .cif (***3 e 17 y <br />�'SpZvi 14/7 EZC <br />Water b Soil Other (specify): <br />1. Sample Type: Air <br />2. Analysis - Test series requested: rei /r Ze. . <br />3. Field Data - Preservation: 7 4- 12 . 3 7. 13 <br />r IA s c..c).•.r/. t":44 ' SeJt s "` rte. /O. ds 4 - 414 --ad , 3 <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 />QAC Date <br />Page 22 of 23 <br />