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a.v14e1- <br />1.111.011C U UJI UUe <br />,, [ <br />A 4 T +' .+ , itr*F� <br />rr',a/1X <br />11-3 -!/ <br />Ferd Fir <br />to: Ise <br />k'.ri_: <br />Time Recd. <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. <br />Sample Date 2 - 2 A' / Time t3:4 <br />Collected By / n ro roovAix 4./f <br />Field Custodian . o ' <br />Delivered By <br />Received By <br />Date Recd. <br />34,/,- /los <br />N! S25906 <br />P.O. Box 1150 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />�'NPr s 0e to 4 7,. <br />C1-4? 4P.. 4../7 z 0 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: f �,. -....r2 <br />3. Field Data - Preservation: ie76. g y 7 3 c ,-J t 2 Z 6574 - 't 1 °� <br />t' s e , , ,`.1 62A t, V ` , O. i i =,4 /-i O ? _ s <br />?-1CP 1 <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 39 of 41 <br />