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wMCA <br />- to es nat n <br />jf�� <br />11 ` <br />S-)2... i 7- ) <br />l <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 />Sample Submittal i :'- $26388 <br />C: P.O. Box 1750 S: <br />Canon City, CO 81 <br />Sample Loc./ID No. C W /14.- <br />Sample Date S '/ S /2 Time /6 Z S <br />Collected By , d H TPi+ 4 a 1 / <br />Field Custodian go 4 7 o ....IA e. ,, t <br />O S D t i <br />o <br />j ,� °- <br />Sample Type: Air Water / Soil <br />Analysis - Test series requested: re, <br />C'. u <br />3. Field Data - Preservation: r o c. 1 1 .3 <br />Li. o2 r. . ilr <br />049 Y <br />• <br />'in f e - <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 />QAC <br />P.O. Box 1750 N: P.O. Box 700 <br />Callon 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 />0- a et Z G 6 pv v. 2 -1 ' cam •. <br />( Lt/ • 7‘(1)( <br />Other (specify): <br />• <br />,,//y�J 2, 5 r <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 Loa__ — <br />