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I.VLLCI <br />v1i•WS6 UVaslUa &UU <br />, .�. CO <br />M 11 - I3 <br />Cj 3v <br />Sample Loc./ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />S MI5 <br />Sample Submittal <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cafion City, CO 81215 Cafion City, CO 81215 <br />S' cv c(.1 n <br />Sample Date / - /6 - 2 v 13 Time / 0 S <br />Collected By J <.) A C 4 <br />Field Custodian 4.9 6 if r;.. <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1 y <br />" <br />G o/ <br />1. Sample Type: Air Water l Soil Other (specify): <br />2. Analysis - Test series requested: ( ( Jo I <br />3. Field Data - Preservation: T O / �4 g j ,,# -7 O6 f' E i 3 9 a ,, S `* ' -, } v Q ( <br />1 i c <br />O . 5 L 7' A //,14 0 ) . S - ,-4-i-`. ..l <br />•) t- <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 />aye c V <br />