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%AMIcr <br />1 4 1 w 0 71e .ds <br />e , am `►- <br />d G <br />l' ∎ K , <br />1 Alt x <br />/1— 1 <br />...0' <br />C ISY <br />C: P.O. Box 1750 S: P.O. Boa 1750 <br />Callon City, CO 81215 Canon City, CO 81215 <br />kc.= No. /pa A ('P Lab. No.(s) <br />401004.00 fI 2q•l e /L cl1 <br />c4 f)./.„ <br />t - <br />C Astodian 1r� 7 - 0 .�t r: •� f <br />1. <br />2. <br />f. iaridating circumstances? If YES initial ( <br />{ ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />{ L . '•_ <br />Water Soil Other (specify): <br />Sample Type: Air <br />Analysis - Test series requested: ( r 40 <br />3. NMI Data - Preservation: / • C- l ( 4 -, - /- l 7 1 9 ( r _ � J / "'�`• it <br />P f /� # ( 1 A �f. 1 , • ! (. �'' e, , 1 �� �.4� C.�. 4l / fT V, , , M . <br />SAS' / <br />4. lime a►sis required by (If not Holding Time): <br />S. Sliacial handling conditions or other instructions: <br />C01141 NTS - Explanation of noted items: <br />QAC <br />Sample Submittal <br />M:. MOM <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cats: <br />j/! A r a G� a�w 4, t �a <br />1? e l 5.: 1 ("e.0 Ai itioW <br />(s ue. 1j a <br />" y- _.. <br />) and explain below. <br />N: P.O. Bra 714 <br />Nucla, 'CI <br />) If NO, explain: <br />Date <br />