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•__uIIv_ <br />-SIte Destination <br />(J <br />3 a 6 . f'1'1� <br />/ <br />1, t <br />‚- <br />/ <br />f <br />" // <br />� <br />61/1 f <br />bii y -� <br />_' cV <br />[lY <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ; : S 2 6563 <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. J1i h Q ` // , i 6.1-. /9, Lab. No.(s) <br />Sample Date `7 ` 6 - / 2 Time / } 0 <br />Collected By /.3, �. 7 p , ., .11 <br />Field Custodian /! / ! + :- jr it c, �r <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />off <br />Sample Type: Air Water <br />2. Analysis — Test series requested: 7-4, l is � 2 <br />a`- <br />< <br />3. Field Data — Preservation: 1' / ?. . <br />7..331_ c Z 7 <br />/ cr <br />/ c:' ii F� � 1L = A t <br />6. Invalidating circumstances? If YES initial ( <br />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 />Laboratory Destination if not Cotter: <br />//}} fi <br />L., • h <br />5 Soil Other (specify): <br />�t r� ,gyp <br />) /7 ,o (-•;, , f- s305 <br />' S <br />cAr <br />A 1.90 >1'O <br />r <br />/ L /° j /(2/'/A-//Ala 2. <br />5 .�. <br />) and explain below. <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 23 of 23 <br />