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I.ULLC[ <br />Vaa -OILC uca sanaaavaa <br />! " •, <br />'. <br />1.1-41 A , C-,(..L <br />-s• /O - / <br />a.p <br />. ,- , <br />A , • .a--- <br />Sample Loc. /ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal it S 25167 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />S g os <br />Sample Date r7 �' 0 2 Time / •0 U <br />Collected By r <br />Field Custodian /- j: ` c - <br />Air <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: / / ' • 7 <br />�,� �,: 3 �. I <br />• <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 />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 />r <br />4 1/ <br />Water r Soil Other (specify): <br />f <br />,.:, r o <br />II F. 0/ f ,.z Z S G* C e,)(1 <br />f 1 . 5 / No', <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 18 of 20 <br />7 <br />