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Lv«ci' <br />VII'OLW ucaaW IiUU <br />aiSe) 4.1 Ta.....%./€v <br />Feffleive <br />, <br />6 -3 -/l <br />Fed (A- <br />la : !S <br />A/,;(4,------ <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2 303 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. Gc/ -- A 0 2 S Lab. No.(s) <br />Sample Date g '.2 2 d'/ 'lime i A l r <br />Collected By 1> o b Tir,.: Al 4._ 1 <br />Field Custodian i fo .✓.tj, <br />Delivered By <br />Received By <br />Date <br />Time Recd. <br />1. <br />v •v -♦ #d' <br />Sample Type: Air Water �° Soil Other (specify): <br />2. Analysis — Test series requested: C / <br />3. Field Data — Preservation: r4"-- /7 1. gi Cf� 2 f6 <br />e 5 z �- ...) l). S / / //4/O 2. 5 ...se <br />Ste. 0. 7k <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 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Labotatory Destination if not Cotter: <br />L4 40- 4 /Chef 4 7.-% <br />Z S 9! 54,64 2 k �y • <br />n s ,e. Lafr g z of <br />Page 36 of 41 <br />