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C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. . ' Lab. No.(s) <br />6 23' 12 rime 3 0 <br />Collected By / U F' R A cc A Data Entry By <br />Field Custodian ) rOri e ✓' r Laboratory Destination if not Cotter: <br />Cotter Off 5rte Destina -- /l P t r c_- c ft,.ri •► S f... <br />/74- t . <br />� 7 re e - ,q <br />(" T w . r Ivk 2zgU <br />Sample Date <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i �� S 532 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Time Recd. 4,44, 6 A if <br />1. Sample Type: Air Wate Soil Other (specify): <br />2. Analysis — Test series requested: cJ f! <br />Date Data Entered <br />3. Field Data — Preservati . T n f 7 . 2. �7 7. 2 Y � , , ?, Y? 3~�, S c�''-. <br />y r S r'a n- /.? • r S c c,±r ° D• s L f/ " , 4/a 2.5 <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 ( ) 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 />Page 6 of 6 <br />4 <br />• <br />/ CI./ - <br />cd en <br />6,-19-ft <br />icte <br />A <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. . ' Lab. No.(s) <br />6 23' 12 rime 3 0 <br />Collected By / U F' R A cc A Data Entry By <br />Field Custodian ) rOri e ✓' r Laboratory Destination if not Cotter: <br />Cotter Off 5rte Destina -- /l P t r c_- c ft,.ri •► S f... <br />/74- t . <br />� 7 re e - ,q <br />(" T w . r Ivk 2zgU <br />Sample Date <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i �� S 532 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Time Recd. 4,44, 6 A if <br />1. Sample Type: Air Wate Soil Other (specify): <br />2. Analysis — Test series requested: cJ f! <br />Date Data Entered <br />3. Field Data — Preservati . T n f 7 . 2. �7 7. 2 Y � , , ?, Y? 3~�, S c�''-. <br />y r S r'a n- /.? • r S c c,±r ° D• s L f/ " , 4/a 2.5 <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 ( ) 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 />Page 6 of 6 <br />4 <br />