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lAPIL F <br />JL1'011.0 Lc0 IU NVL <br />. f <br />Fe p — <br />/ ;)3�z ynros <br />'T a k-}_ h <br />Sample Date / 2 I #i <br />Collected By r, 4 <br />Field Custodian /.l <br />1 < <br />C: P.O. Box 1750 -- -� <br />Cason City, CO 8121$" <br />Sample Loc./ID No. g r <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER G SAMPLE SUBMITTAL AND TRACKING FORM <br />Sap1 bmittal <br />• <br />1. Sample Type: Air <br />QAC <br />> Time / _z 3 <br />„ ^ r' <br />( <br />3. Field Data - Preservation: 1 <br />' • r; <br />• <br />2. Analysis - Test series requested: <br />( ) Check if additional attachments. <br />QA Review: <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Nucla, CO 81424 <br />Canon City, CO 81215 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination not Cotter: <br />j <br />l M - , <br />Iv ;*.' : 7 % f <br />Water � Soil Other (specify): <br />r� <br />A /V, 0 .s <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 />Sampe valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page 8 o18 <br />