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LOLLCl <br />V11 -011C 1/C3HPai1Uu <br />4' h 7- 1. /146 <br />raj, x <br />e ix <br />F , gie FA <br />!I <br />7.0 <br />- � <br />i <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. SA' A 0 v/ <br />Sample Date ?- / 7 .2 ill ' / 0 <br />Collected By 13 d 4 r <br />Field Custodian & L re Al" w <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />1 el, <br />Water Soil <br />Sample Type: Air <br />Analysis - Test series requested: (" <br />S25910 <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: n <br />X39 sit e 4.10 ,"y. <br />r 1;0 ,4° , 1. V a ' ' 7 4J 0 <br />Other (specify): <br />3. Field Data - Preservation: f / t t. % 7 7.5` 2- Z 4l z. s <br />r _I 2.46 c, z. , 0,5 1 / !f,///a , <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 />) and explain below. <br />COMMENTS - Explanation of noted items: <br />) If NO, explain: <br />Date <br />