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401,11e1 <br />vu -olLC uwuuriiuu <br />f - <br />F• ... <br />f -a <br />. G- <br />/o. y S <br />.r: 6•:35 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Calton City, CO 81215 <br />Sample Loc./ID No. S 1) g ars <br />Simple Date t i " ' 1? Time S 0 <br />Collected By At) G l <br />Field Custodian f o , ri <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water 1 <br />2. Analysis - Test series requested: ) � <br />3. Field Data - Preservation: 7 u 2. 9 <br />r /II f I.2.S <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 />COMMENTS = Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />IT! s26453 <br />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 />t i o t P v 5 4 L C t' f0 t .o S JA. - <br />Avy <br />Ca Sr �, 4,' A'2 6 cJ <br />1 <br />Soil Other (specify): <br />1 <br />f ? / /7,, j iaa <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 37 of 42 <br />