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L.,«VI <br />- 1 e ma t ion <br />41,4 7 <br />.✓ <br />A <br />f „ vf �� <br />�� <br />r . <br />-f <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal : 2 5 25 937 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample Loc./ID No. S C.4 ti <br />t t ' / 0 <br />Sample Date 3- 2 - 2 J' ' Time 5 <br />Collected By )3 . �� j C' C <br />Field Custodian AC a f .� A■t- -.- <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />S <br />Off Dest <br />' t <br />N: P.O.Box700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />r F hiy 2Z.6 .� <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: 4 /42 v - <br />3. Field Data - Preservation: a �3 , /1 /, 0 �!. Z OQ �.,.�e z `' <br />i cto r: }...0 . 8.%'2 r Z J ° 44 ''`'y ectiFe 17. o p-+A.. <br />P pc., 12. / le /4/4/0 a c / L/ 1 G tic A/0 2c),./ - 2. L I/ /' l / L_ 4if=� 'L S' a„ � ( - ,�,.._ <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- 19-of 20 <br />