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a.vawa <br />vsi oiar LReauatIUH <br />} <br />2 14.= n,' i <br />, !'• . <br />t �� ". - <br />' f r- 1-'6 <br />11 <br />a: 4 <br />4 76. <br />S -r <br />C: P.O. Box 1750 S: <br />Calton City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date /0 ` J - .'? /Time 1 .. <br />Collected By IS I 111 <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />q tr /1► �' ! <br />• ^ nM4:it <br />v . /1441 7 <br />QAC <br />1. Sample Type: Air Water Soil <br />2. Analysis - Test series requested: Ts 4 / r . . <br />6. Invalidating circumstances? If YES initial ( <br />:11 s26 1St <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />1 Data Entry By <br />LaboratoriDestination if not Cotter: <br />3. Field Data - Preservation: 7 L/ 1 <br />• <br />may <br />/ S 0 ( <br />Other (specify): <br />4. Date analysis required by (if not Holding Time): $ <br />5. Special handling conditions or other instructions: $ <br />-.- <br />) and explain below. <br />COMMENTS - Explanation of noted items: <br />Date <br />7I. ' z <br />(,) J <br />