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a.vaacr <br />-� suuawL <br />� va� <br />04 6 l e;,, 4c . <br />t IC <br />re.de-,, <br />f4si ex <br />67 <br />7157 <br />C: P.O. Box 1730. S: P.O. Box 1750 <br />Canon City, CO 81215 f Canon City, CO 81215 <br />Sassple Loc./ID No. SW / tZ <br />sample Date - 3 " 2. rune j !; od <br />Collected By JC3 G rart rt 4. <br />Field Custodian 1;,,, ' e <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 <br />Sample Type: Air Water / / Soil Other (specify): <br />Analysis - Test series requested: ( d ct. 1 <br />3. Pield Data - Preservat n: aw /6 • g <br />VitS 5 . :c <br />6. Invalidating circumstances? If YES initial <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />s26418 <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 />y L.cLo• 4 4. i' s .. c_ <br />393 -5‘41, �.ee 6 - <br />f S j l �f 3Z o <br />72f1(d,. /s <br />p_S // L t%' V .5 <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 />Page8of8 <br />