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IiVLLCI <br />VLVOiLG LCDLIU IIUit <br />Lv 4 4 9 ^-164r <br />4 <br />/p jX <br />, <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1 L2 S 24523 <br />C: P.O. Box 1750 <br />Canon City, CO8�12 15 <br />Sample Loc./ID No. !'1 O W / — 0 <br />Sample Date 7-4Z / Time J 3 O S <br />Collected By /...449 7 -'r1A 4 7 <br />Field Custodian 411, T, ,1 G " t <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />U <br />f <br />• <br />S: 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 />1. Sample Type: Air Water I Soil Other (specify): <br />2. Analysis - Test series requested: - rG 4 10 2. <br />3. Field Data - Preservation: T v 4 1 2. 5 ,% g / 5 / g /.. 5 ' 7 s <br />Y /,4 ( "),7 ' Z.V3 u.4/2 , � �}r /,/ /S. l )44 r4/0 312 <br />3 <br />5 3 <br />;�...� <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 />