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IL -MIMI- <br />Vu-auc I,VaU II <br />4 4 aw M 4t <br />91.) }t <br />$ -3- l/ <br />p F-r <br />Sample LocJID No. <br />Sample Date Z — 2a// Time /: ys <br />Collected By /Ca 4 � <br />Field Custodian 44.4 1e. . e <br />Delivered By <br />Received By <br />Date Recd: <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal rlo S25907 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sta.-6 C <br />ec f <br />Sample Type: Air <br />• <br />Water <br />1. <br />2. Analysis — Test series requested: res el* / <br />3. Field Data - Preservation: o.- it . g "h 7 16 r1J ,i p j z t� $ 4, /4.44, <br />riAi s e re.erf9 5. S' ..C, -a s" eac.. / 0. IL PA /A/03. 7. <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 ( <br />QAC <br />N: P.O. Box 700 <br />Cation 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 />/ <br />.2 1 c Sc.. ? '`' S °` � K ,%L �,.. <br />(s ?Q. Idy. , ?Z Ot <br />cv- <br />1 Soil Other (specify): <br />) 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 />Page 40 of 41 <br />