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Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Canon City, / C E O 81215 <br />Sample Loc./ID No. /' ► W ~ 00 <br />S <br />Sample Date /O _2 3 - /2 Time / y 3 0 <br />Collected By BO �� �+ '1 f <br />._ <br />Field Custodian /-‘ Z, ^ A /1 e /1. <br />Cotter Off -Site Destination <br />g. , . 7- <br />/o -/ <br />(: (S <br />ia... <br />st5Ul4 <br />P.O. Box 1750 N: P.O. Box 700 <br />Cason City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not C tter: <br />L <br />fn4, ✓ $ / L C V 0,4 ! ‘ r 1 ' , 1e% 6. <br />3qL 3e ..rt K., 'r i 4' ' . <br />r'et "C,, 1Gcif <br />G� <br />1. Sample Type: Air Water G Soil Other (specify): <br />2. Analysis — Test series requested: 7 b 4 2„ <br />3. Field Data — Preservation: / 3 . / � / 7 �f f 3 J ,/ L 5 J ''_ , i'M S P v _.l 2.. �4 i 5,_ i s - d T'(-v lei'..:2 �cti� r ar 0 . Z O . Z . <br />, . ,9.r -,, /C/ A /�� 4/a CJ ,..ta /Z /" / (J: t-/FA / 9 AiV 1 / 0.a. 7r <br />7. L & I /- , 1 c_t../f/1 // `) 4)t, 5 ,._ 4 <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />s <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 />