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C: P.O. Box 1750 S: <br />Cation City, CO 81215 <br />Sample Loc./ID No. _f/t/' g O � <br />Sample Date O ' / 7 .2 Oil Time / 3:05 -- <br />Collected By gc ra" 4L'f <br />Field Custodian Liu , [o ' .'v c '+ <br />Cotter <br />Delivered By /( <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />Air <br />7. <br />2. Analysis - Test series requested: <br />Off -Site Destination <br />jt'r <br />cX r <br />k ■Y Mx r <br />Water Soil <br /><a� <br />3. Field Data - Preservation: 1 /C, r <br />e c) , 049,0 14rS <br />7 1. <br />6. Invalidating circumstances? If YES initial ( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />� :2_ s25914 <br />P.O. Box 1750 N: P.O. Box 700 <br />Nucla, CO 81424 <br />Canon City, CO 81215 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />� A- L 4b 49 c I• f :> <br />ar <br />F " <br />Other (specify): <br />J o. s L /= /- //No z . 5:...� <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 />) If NO, explain: <br />Date <br />rage Si OT i <br />