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..11.11..C1 Off Si - to es na VL <br />4 <br />/304 ` Ill r t fec/Ev <br />-lf - p- 4yo <br />-r. ilmaltW.Li <br />COTTER CORPOR SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Submittal <br />Sample Loc./ID No. $ 111 / 4 <br />Sample Date ` / - /2. Time 9 ' .� 5`"' <br />Collected By • u ( Th 4A C .1 <br />Field Custodian / u 4 �� <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />D ti a <br />2 L 14f/; 4 ////1/ c <br />6. Invalidating circumstances? If Y initial <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />:".2 s26368 <br />S: P.O. Box 1750 <br />Callon City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />E SP✓ y Lc1a044,1-• 14,_ <br />2393 4/ �v Pk <br />4 X 76'61 <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - Test series requested: cJ e S <br />3. Field Data - Preservation: 1 7 5 0 /7 2, 57 (9 c n. : 3 2 6 L.. C 7 <br />/MJd ? 2 (2,,.4. <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 />-Page 30 of 30- <br />COTTER CORPOR SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Submittal <br />Sample Loc./ID No. $ 111 / 4 <br />Sample Date ` / - /2. Time 9 ' .� 5`"' <br />Collected By • u ( Th 4A C .1 <br />Field Custodian / u 4 �� <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />D ti a <br />2 L 14f/; 4 ////1/ c <br />6. Invalidating circumstances? If Y initial <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />:".2 s26368 <br />S: P.O. Box 1750 <br />Callon City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />E SP✓ y Lc1a044,1-• 14,_ <br />2393 4/ �v Pk <br />4 X 76'61 <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - Test series requested: cJ e S <br />3. Field Data - Preservation: 1 7 5 0 /7 2, 57 (9 c n. : 3 2 6 L.. C 7 <br />/MJd ? 2 (2,,.4. <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 />-Page 30 of 30- <br />