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1.o1LCr <br />1 e es I <br />pr ?2r it <br />(WI <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. Y � 0"1 ' ►�" � <br />Sample Date ?+/ 9 'Lyme 1 d o <br />Collected By /go }, Tom,, 6 <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Off S ' t D t ' nati nn <br />f G ! N <br />Y�1 <br />1. Sample Type: Air Water 0 Soil Other (specify): <br />requested: <br />re <br />2. Analysis Test series <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />3. Field Data — Preservation: t i / SR S;fei / 7 0/ ' 1 '1' J 3 Q 3 C'e 5 I )- <br />cc,t,ci. , 1 ��. 1� ✓G.S j <br />I A N N U? 2 O 9 lL , /Cuf4/9 ` /v, v, <br />: :2 s25917 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />215'3 Sc,/7 r e k <br />QAC Date <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 />