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unser <br />'WON PeU1210011 <br />1:401 t; <br />t <br />iCelf-A. <br />o,, 1 4X- 6 7 <br />• <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />I tit RUIN <br />4-1 <br />Beeigek Loc./ID No. <br />• — <br />C: P.O. ftx S: <br />CO 8i/I3 <br />At iovi— 9 <br />P.O. Box 1750 <br />Canon City, CO 81215 <br />Lab. No.(s) <br />liteOkkdkate 7- 0 m a 0 Date Data Entered <br />60- 1 1 ected By IZ <br />3601911.1041110 8,‘ 7. <br />„filaW"tielSy <br />Received By <br />1. Sample Type: Air Water <br />ditedyels - 'bat series requested: /4 / /r v .1.. <br />6 . aPecial 'WNW moons or other Instructions: <br />Check if additional attachments. <br />QA.Rovitw: <br />liakaphivHdid? YES ( ) NO ( ) If NO, explain: <br />t al a I a atieht <br />Data Entry By <br />Laboratory Destination. <br />I <br />. <br />1 a &)y tJHorr <br />v <br />(' S oi l Other (specify): <br />— SW Data - Preservation: r *-- /2o aliA.Eg st. itzo : <br />• ei <br />--4/4 <br />/-4 /71/..,1 2. /7 /. <br />Z IA '/J /, // <br />4. Date analysis required by (if not Holding Time): <br />6. 8npralikkativq/ circumstances? If YES initial ( ) and explain below. <br />comikons Explanation of noted items: <br />.s, <br />k QAC Date <br />..... 0 <br />zs -4 <br />