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l-Vn1 Cl <br />1/11 - 011C LCD111U1L1U11 <br />4 .y,, t ? OAnr -+f <br />tA(.J r X <br />, <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />3. Field Data — Preservation: ! c 21 TI <br />K /4 Se 4 5- 6 C el. <br />e s .� <br />4 fi— <br />s26813 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc. /ID No. _ce A Cc) P Lab. No.(s) <br />Sample Date 02, S "2 // S 0 Date Data Entered <br />Collected By "4 �p-' -1 e -► Data Entry By <br />Field Custodian l-30 4, r%..1 " t Laboratory Destination if not Cotter: <br />Time Recd. <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: r •• <br />_ ` <br />'C. — /c4 //4/0 2 .F. <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 7 of 8 <br />