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a.USaar <br />4111-0l1ffl UV UU UVU <br />I 10.411 C t <br />F:e4 y <br />terif <br />FE -e <br />l e.93- <br />K b'ssr <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 />QAC <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Callon City, CO 81215 <br />Sample.Loc./ID No. S + 4 •,4 e0/ <br />Sample Date S a. Time free <br />C o l l e c t e d By ) 3 o TQ n.1 a i <br />Field Custodian )? J <br />• <br />IZ stint <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: <br />ell Pep y 3wG �+1>l ((vi S <br />3 ? Satf C'�•e /� 4Iy <br />(G s ?ee Li y! $ 260( <br />e,, „ <br />Sample Type: Air Water 1 Soil Other (specify): <br />Analysis - Test series requested: el m` ,f q <br />3. Field Data - Preservation: 2- I e il 7• / C p,j 1 (i . - t f <br />�►��� �d�f .'1!'; C a "`, 0. v L P4 NA/ 2. <br />5- - C-5.4". <br />, 4. Dale 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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page- 36-ot42 <br />