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a.uatur 4 <br />4 .011‘ ansuu uuu <br />AA TA,14V / <br />/ k <br />foj(, F <br />Fg - G <br />Y14- 19 <br />id CPs k <br />kis S L:55e 4 <br />C: P.O. ten 170 <br />Cailt'c x1215 <br />Sample LecJIDNL 5141 -o' r 5. <br />Delivered By <br />Received By <br />Dsite Recd. <br />Time Recd <br />1. <br />2. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal tt s26457 <br />S: <br />Sample Date 1 ' S ' /. Time f t: 3 Q <br />Collected By flea ( T re),/.1e: �.•.� •1 7 <br />Field Custodian AA,. �► <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 />err P r ( 1 Z 4 Z0, 4 /a.° ' • s l .. c <br />Sample Type: Air Watery / Soil Other (specify): <br />Analysis - Test series requested: nof t <br />3. Field Data - Preser vation: 7 � • i /7 ' 7 3 r (,.� g. Z l� Z.1 <br />rr n ! "404#1 of, 1.67 -. ��1T -c S ). S L. 4 #44 - t C <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 />) 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 />?C%;;tw.;r+•; , _ , .. Page 41 of 42 <br />