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LV«Cl <br />V11.011C LCD MIIINUll <br />i'i.,+rs <br />I!. <br />IL <br />l <br />OAP <br />Delivered By <br />Received B <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. 5 GI, /1 (f' <br />Sample Date / J - / ' -' /,� Time J i 41 ° <br />Collected By X,).1. � �' n ✓t ' - - <br />Field Custodian Ai; A 7 -. A <br />Z6r 7t <br />1. Sample Type: Air Water -J Soil <br />2. Analysis - Test series requested: .P <br />3. Field Data - Preservation: T 1. 7 <br />l 7A*11 ■64 : / <br />Z L. <br />0 (/ r � /fJ. > / J,�..�.. <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 ( <br />QAC <br />*, 1 • <br />s26S5O <br />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 />f Y <br />�.- 4/ y S.? J <br />s <br />Other (specify): <br />/( /4 /7A" J V. p ..1,..j <br />) If NO, explain: <br />Date <br />Page 9 of 9 <br />