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C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Loc. /ID No. (*.J I / L Lab. No.(s) <br />Sample Date / 0 /I /'2 Time , 670 <br />Collected By 17 <br />Field Custodian ! 1 Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• , <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i .' S 26514 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: ( e 4 <br />3. Field Data - Preservation: / /'J, % (5 n .� . y . <br />.r' <br />0 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />( <br />f - f .. / <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 />a.UIwa <br />•711 LiMbillilt Iivn <br />`' <br />—/ . f / <br />� L • <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Loc. /ID No. (*.J I / L Lab. No.(s) <br />Sample Date / 0 /I /'2 Time , 670 <br />Collected By 17 <br />Field Custodian ! 1 Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• , <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i .' S 26514 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: ( e 4 <br />3. Field Data - Preservation: / /'J, % (5 n .� . y . <br />.r' <br />0 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />( <br />f - f .. / <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 />