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C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. (4) ? II <br />Sample Date / 2 / /. Time / ) s <br />Collected By 4 Tp� <br />Field Custodian ./!:,,,A:= _s „ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal Rti? S2055 <br />Wi <br />Sample Type: Air Water / Soil <br />1. / <br />2. Analysis — Test series requested: n .,-/ a / <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon 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 />/ - - ,r1 • 49 � c. !1 _, •• r l • _ , - 5 - �•- <br />" tVL <br />„ L�i1! (v l <br />Other (specify): <br />3. Field Data — Preservation: f .o Sy `/ y 7 /t1 7 7 2 (".)- . , 726(4-rd <br />�� s . . . V,2 0.4 Z , 5 <br />':), 0, <br />T 1 <br />c <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 8 of 8 <br />. VLLV1 <br />v11 - �711C 1/C.}Ll <br />/��) <br />At VA <br />. . l i e. <br />12 1 -Zb/ 2- <br />/0:SO <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. (4) ? II <br />Sample Date / 2 / /. Time / ) s <br />Collected By 4 Tp� <br />Field Custodian ./!:,,,A:= _s „ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal Rti? S2055 <br />Wi <br />Sample Type: Air Water / Soil <br />1. / <br />2. Analysis — Test series requested: n .,-/ a / <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon 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 />/ - - ,r1 • 49 � c. !1 _, •• r l • _ , - 5 - �•- <br />" tVL <br />„ L�i1! (v l <br />Other (specify): <br />3. Field Data — Preservation: f .o Sy `/ y 7 /t1 7 7 2 (".)- . , 726(4-rd <br />�� s . . . V,2 0.4 Z , 5 <br />':), 0, <br />T 1 <br />c <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 8 of 8 <br />