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l.OLLCI" <br />VI I. 01 It 1/CDI1LUI1U1l <br />;(1; C 1:; A.- Li <br />).mil.# T <br />P"4. �r <br />e) - 6 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 <br />Sample Loc. /ID No. ci./.470 " r <br />Sample Date 9 -2 J ` / .2 Time / <br />Collected By A4 , c <br />Field Custodian /1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Sample Submittal <br />3. Field Data — Preservation: 7 ) 6, R <br />22 <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Desti nation if not 1 Cotter: <br />/ <br />1 .3 3 S ! (✓ 4' K' L /7 y. <br />cx tel 7( cJ <br />/ " r• '• - <br />1. Sample Type: Air Water D Soil Other (specify): <br />2. Analysis — Test series requested: T* 4 l? <br />p 7.a ,J10y !' s •. <br />0 7.? i• -r- l _.� <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 />Page 20 of 21 <br />