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l.vltaa <br />v11-0111V LC8ua711uvn <br />t o', raftileo -if <br />re cle <br />.''. f. ) 111 A' <br />F ec1 /x <br />g - ;L - tI <br />1: lS <br />ii,: 6: ssc <br />COTTER RPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1� <br />Canon City, CO 81215 <br />Sample Loc. /ID No. ' 9 <br />Sample Date 9 Time /� S <br />Collected By 3 ;Y ..C. <br />t�ti ,i C '� t <br />Field Custodian A : - - =° 4 <br />Delivered By <br />Received By <br />Date Recd. <br />1. Sample Type: <br />Air <br />Sample Sltbmittal <br />S: <br />P.O. Box 1750 <br />Canon City, CO 81215 <br />Time Recd. S <br />t. '44 <br />Water '" <br />. ' Soil <br />2. Analysis — Test series requested: f G A 1` / ' ta. . <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />,s++` y I E L .r ,r b f ' 1 ' , Low <br />, **.e 2 6 0/ <br />Other (specify): <br />3. Field Data — Preservation: / 4L- lit 3 il b ' q) ep =' • G 2 ? 6.561 s <br />44, t: r ! (; ! 4_ # i/i/ g i 1�+f ►- I c r l ,s , e PI <br />2 1 6 1 0 - "- <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 />( k ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />