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( <br />COTTER COR RATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Date ' • .3 - ! L Tune in: 1 <br />Collected By .t ( <br />' <br />Field Custodian b <br />Cotter Off -Site Destination <br />Sample Loc./ID No. �.. r,.. •• ) <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />C: P.O. Box 1750 S <br />Canon City, CO 81215 <br />2. Analysis - Test series requested: <br />ample Submittal <br />C <br />1. Sample Type: Air Water Soil Other (specify): <br />TO 6 W <br />3. Field Data - Preservation: " ) 8 .t 1 r/ L. I(/ Cr.- c' . 3 icCX? <br />.5 F .5 tAFA 14 Sew . ....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: p let n' f y u I SC A 1 kra I. e . c f:, ,} <br />8, c a c_rt'e- ( � rr i e L 0 S s A l t,. ' $a.-� -c.� 'x <br />Vr Check if additional attachments. <br />QA Review: <br />!:2 s26552 <br />P.O. Box 1750 <br />Canon City, CO 81215 <br />Date Data Entered . 7- 5 - . <br />y� <br />Data Entry By / 1 . c� <br />Laboratory Destination if not er: <br />C 1n e U 0 y YC.c +e, r- t S I vt c <br />x.3 / 1 "+ C � ..a e 1� ■.thi <br />f e4,240 (rte e v- Luy F / <br />/coo <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) 1 �►�' <br />QAC Date <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Page 21 of 21 <br />