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l.Vtitr <br />l/11'O11 il' aalm aavm <br />J <br />L N; , <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Collected By - ~ <br />Field Custodian l' <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . :2 s 25152 <br />Sample Date -. '' !1 'line �c ? - <br />! <br />(1 " A t / D Lab. No.(s) <br />1. Sample Type: Air Water <br />2. Analysis — Test series requested: <br />3. Field Data — Preservation: 1 / ? 6 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />3 <br />Soil Other (specify): <br />r <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />r > <br />r ! 7 7 <br />/ <br />2 <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />