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LAJIl.er <br />V11 11FAL&LYWVu <br />it <br />"� - � �= ' <br />— 3 ,yea/ <br />�. - <br />! `- :. -1 ,y( <br />Ae, -./f <br />fit1 r C ry , <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 j <br />Sample Loc. /ID No. S W tai. <br />Sample Date " 5 Z J I/ Time ft , 3 Date Data Entered <br />Collected By '.. t' > -.� <br />Field Custodian 74: Arr✓e L <br />s2I155 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />"{ j ( � If / <br />0I <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: ( , ) ,- -, .' 0/ <br />• 1 <br />3. Field Data — Preservation: / f. i'7 / q. g A l) 7.7 ( -e/ c 23? L-` d' i } /i <br />"!.✓ c C t " , ,‘.. -. . ` <br />'/ fir' 4 l .7 : t ` ` r9, 1 / /I / 1 > ..*A'. E <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 />Kage Tb 0 r2U <br />