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a.u <br />J 11i LCD HYO Wlarn <br />/-141. <br />f <br />i c'xr. - <br />-!/ <br />$ -if C <br />2.0 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />Sample Date <br />Collected By fe d <br />Field Custodian /--?:) <br />Delivered By <br />Received By <br />Date Recd. <br />Time R Cd <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />3. Field Data - Preservation: <br />( <br />S7 —, — / . 0 / <br />Sample Submittal <br />S: <br />-20 /4 Time 5... <br />1. Sample Type: Air Water + / rg �} Soil <br />2. Analysis - Test series requested: [ ,, <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 />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />S259 t3 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: r <br />41Y 1 fl <br />Other (specify): <br />‘., <br />$ a. s L/r4 <br />) and explain below. <br />) If NO, explain: <br />Date <br />r'a j I el <br />2 5 <br />