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•-•v <br />4.111`011C 1"151111111.11/11 <br />&)Z / - 7∎11 1 <br />/....- <br />FF,16' <br />r... . G y <br />T <br />I, 3 5 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :2. S SS <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. Y n 5 � t C t4 I / Lab. No.(s) <br />Sample Date 3" 9-20/? Time 1 3 5 0 <br />Collected By 17 o 1, r Qn rc G I <br />Field Custodian q, ' /eel-4G <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sampl pe: <br />• <br />Air Water e Soil <br />2. Analysis — Test series requested: 4 /P .2. <br />3. Field Data — Preservation: <br />S: 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 />� <br />2 3 9 5e;,.,/7` <br />( V0.., W , 2Co ( <br />,�✓✓ <br />c V <br />mss- ) z .s� <br />/ ( r4.Y//l/0 <br />LUf l /L 4'`,4 // So., S' <br />T"" r 'HC.B9 <br />C. 9a3 <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 />Other (specify): <br />Page 19 of 19 <br />