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. UIIVr <br />vu -ouc a/cowman /AI <br />,, /: E. <br />64 zy <br />10 8 l2 /It, r5 <br />i-/ ,_ 1.4r 1.1. <br />c <br />C: ' P.O. Ron T750 <br />Canon City, CO 81215 <br />S ample Loc./ID No. <br />-• Sample Date' /D • 1 + R Time / 6 Collected By / I } ` { <br />Field. Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />_r- <br />I -1t. ., <br />Any <br />sIU47 <br />S: P.O. Box 1750 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 />2 / . ..I[ (-le \ t . / 1 7_ • <br />G• S y. ? (- <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: :4-1,- <br />3. Field Data - Preservation: f ,) / ? - , , /' 7 2 " 7 0 ^ �- .. ,ifil <br />~ =' z.. %'• z <br />.4- i <br />! r c r. *. if. 1 . ..y a!' a- .S , } c:f. i ' Y'�`r'r7.�f` 7 L ,� .._ <br />r?.... /. ,�..,1= .. f -/- H 'S _ -- JI //1.1_4 . . . ;7 - ;.. _ ('- / . /, / 3 - <br />/ <br />' ! f ' '2 p F .' ! 1 r • t [ f.9� 7 :fY'1 I a , S , jt� <br />fi r' ' f t! ! ? , <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 />d <br />( ) ''Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />;QM Date ° <br />'J <br />Ze <br />sJ• <br />Page 7of7 <br />