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LA MM <br />ll WOE IC VWWUiLEVU <br />yy�� <br />' ,3r?4 7# Ai. C N <br />1 i , t <br />t( 1712_ <br />I <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />O. <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. Y%- 1 P1- <br />Sample Date /1 ' "6 ' ' ? Time / •. ° v <br />Collected By N `' T}°fl't G <br />Field Custodian /. 4 , b +'r+ �+ e- f <br />• <br />2. Analysis - Test series requested: ( c' 2 <br />3. Field Data - Preservation: <br />r r <br />6. Invalidating circumstances? If YES initial ( <br />Y r... <br />st$7u4 <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 Destination if not Cotter: <br />4 c f,, er f 1 r C <br />7 - . 4 / C ek <br />r e40 4c/y. 2Z6"0/ <br />3b <br />Water / Soil Other (specify): <br />fr/ 6 2Z r , ( - o <br />S ° c , Z. F4 (V//J f <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />) If NO, explain: <br />Date <br />Page 6 of 6 <br />