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Sample Date 12µ3n ` 1! Time / 2 3 C7 <br />Collected By ) 6 1 <br />Field Custodian L . 4 T'' 1 II e.. r <br />Cotter Off -Site Destination <br />Delivered By j3.r - . coArF.rt I ,v <br />Received By. .L'', X' f I <br />Date Recd. f • 3.1 <br />Time Recd. $ ' ;(,) <br />1. Sample Type: Air -�--� <br />2. Analysis - Test series requested: f h / ,e , <br />6. Invalidating circumstances? If YES initial ( <br />C CU <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />St$173 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cafion City, CO 81215 Cafion City, CO 81215 <br />Sample Loc./ID No. P Q 4411 Lab. No.(s) <br />M!'5 I <br />.. j a►. lei t A w./ <br />Water S Soil Other (specify): <br />( <br />3. Field Data - Preservation: - I }G /. 4 7 4 ems, ..a. . 13 ( 2 <br />� ,rte J t i.. -+� •� <br />.^ 1 L i }/1c/ 4 / 0 se "s :J' t ,� lid' "N Yiv.. i VE <br />67, PA Al ,V1 A c.),.,.. /I-I- if; a /'' /14/t') <br />1 a 4. T°f ,� . Sr/ "...i <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explaiU <br />QAC Date <br />) and explain below. <br />N: P.O.Box700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: , <br />�' 7 k fj_ �f fir' < ? f s r t , : s <br />/ 1 � <br />.0.. .as)e:21- 2 :. <br />.1044 <br />