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l.VI►CL <br />Vii.01 LC i/COLmauvu <br />f , Jf <br />r Y/' Ty <br />. <br />70 <br />It ao <br /># .g.--- <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 56,./ — A W <br />Sample Date 2- 17-20d Time <br />Collected By S 7 A.~ •we <br />Field Custodian /S v G % v.✓.✓c -� <br />to : oo <br />7 <br />1. Sample Type: Air Water 1 Soil <br />2. Analysis — Test series requested: (? <br />(1 0 <br />3. Field Data — Preservation: ra ` /y. z / '7 7y "..j 2 4 1 / 5 dr <br />v ? 2.2 A.. s r t C. S k',l/ 5 2 .5 <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 />525909 <br />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: -fir <br />7 ..'Lest / Z 0./G• for. t y° S `.a c <br />4,./y ZCO/ <br />Other (specify): <br />) and explain below. <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />) If NO, explain: <br />Date <br />