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wl,..UILVI <br />- to at on <br />lf <br />16, <br />fir - <br />faro,11 <br />4 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal �� S 26170 <br />C: P.O. Box 1750 S: <br />Cation City, CO 81215 <br />Sample Loc./ID No. ,f — 6 <br />Sample Date f'Z `2 ? J/ rune 10 <br />Collected By it 4; ' "'n +'''g n r <br />Field Custodian l -� 0146 P! <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />1. <br />2. <br />Off Si Desna i <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 />Data Entry By - <br />Laboratory Destination if not Cotter: <br />' : - <br />Sample Type: Air Water <br />.�• - Soil Other (specify): <br />Analysis — Test series requested: �` r 4 ft <br />3. Field Data — Preservation: <br />y. 7 ! f 7 7..4 ",.� 722 y , <br />—1, 4,f <br />a : g ,�,� 1,. i'i • .` 1 , � .7) .-...j , � L I ' . -4 r / <br />. w <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 />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />) and explain below. <br />) If NO, explain: <br />ti <br />Date <br />.. • <br />