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k.V «or <br />vie -ouo uve a iuu <br />t . " - <br />/I • Ex <br />/U:LI) <br />- 6 =s 3r <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM - <br />Sample Submittal t: S 26171 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. i lk" - 7 Lab. No.(s) <br />Sample Date -' <br />Collected By / ' � r h ` '' , <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />� A A 4, <br />1. Sample Type: Air Water V Soil <br />2. Analysis - Test series requested: i'"' <br />3. Field Data - Preservation: f r ' `- /4 <br />0.63 , , / ' if //:/,/, r <br />/ 4 / , r if /11 S t 1 <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />E n [fir Z . i „, <br />Gay . t <br />Other (specify): <br />/ , 3 s ✓ J S 3 4? ) , t ? <br />X <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />QAC Date <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />x ,,_. •. ate Oh. okSa .r w <br />