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I,. MM <br />via aicae.mswvu <br />/-1' <br />"0:7 <br />I <br />a <br />x <br />F of — <br />,(g / <br />7. <br />' <br />— . '''— <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :::1S25912 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date g /7- 20 /1 Time f/ S - S' <br />Collected By / I 1 ✓`" / <br />Field Custodian v 13 et. <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 />rte P- y L4 O.. 4 /0 or ( 4 c <br />23 i3 SG/ C 4 k / W y, <br />£,fJf 2 60/ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />4 <br />1. Sample Type: Air Water I Soil Other Other (specify): <br />2. Analysis — Test series requested: �r f ie l <br />3. Field Data — Preservation: 7 1 • y 4 ,9/ 1 / F02 2.9s $ <br />r „ . 2.4 s' �. � s :. r _ G? `_pipAJ O f/ 2 , <br />-407 0 2r a FA ///#!4 Z / C /A //A/6 2 o.. <br />I , / L u r= /1 /4 S <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 />