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11..O11.6Cl <br />via-oaav mciz N1lNl.VY <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />Collected By ' . <br />Field Custodian <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . i s 2S' 53 <br />;14}....4 )(I/ <br />Sample Date =',; / ' Time /0 A t7 <br />L <br />S: 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 />F c 7 7 .; 7,4 y. <br />I'1 - <br />•f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. .' f <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: ' <br />3. Field Data — Preservation: / f'L 1 <br />97" <br />7. • 3 <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 />Page 14 of 20 <br />