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l.Uf.LCa' <br />Vaa -,uuC a,catiIuasavu <br />8 -! fr!/ <br />7. 0 <br />q'' 3-0 <br />/..%- S---- <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date L / 1 <br />Collected By 6c) <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal , . S 2 5 911 <br />S / Lab. No.(s) <br />- 07./ Time <br />) <br />PL <br />2. Analysis — Test series requested: 17-Tv <br />l <br />{ o� <br />3. Field Data — Presery tion: / <br />5 e n <:t ,., cf, 2. s -,- <br />6. Invalidating circumstances? If YES initial ( <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Type: Air Water / Soil <br />14 . <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />F iv e v y 1 c. c. 4. ., 1' <br />Z � , -'` � r e e k # cam y� <br />J47 so' ) Idy. OZ 2/ <br />Other (specify): <br />7 . F A /1 ,4f 4 2 , .� <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) 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 <br />Date <br />