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. UIICr <br />to n <br />£ 7' ,v��.✓ <br />/ <br />-5 -J / <br />-41-446 g <br />reei E X <br />5. <br />COTTER CORPORATION SAMPLE'SUBMITTAL AND TRACKING FORM <br />Sample Submittal i �i2 S 25904 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. <br />Sample Date e- 2.- 20 // Time f 2. : <br />Collected By r0 /Al <br />Field <br />Custodian 43 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />AS O Ot Destigat <br />1. Sample Type: Air Water 1 Soil Other (specify): <br />a <br />2. Analysis - Test series requested: d d t <br />3. Field Data - Presero on: 7•7‘.5 Q # 7 5 s� ��.�.��'. 1/ 5 <br />4 Cdr.- s <br />r /A/SQc0 S. en r„. r/ "`'`"�..5 " G / " /1fiA/O Z. 5,. , -19 <br />S7 /3 7 <br />4. Date analysis required by (if not Holding Time): <br />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 ( <br />QAC <br />Date <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />(d Vy. gzcoi <br />) If NO, explain: <br />image 3Tf41 <br />