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�,1/..«1 <br />Off - Site uesunanon <br />k <br />f r- ' ' <br />�i <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S /3 /� <br />Lab. No.(s) <br />Sample Date 2 - / 2 ' / Time 9 : 3 0 Date Data Entered <br />Collected By /3 • , j. i . / Data Entry By <br />Field Custodian / t ? Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal !;r S26792 <br />nits 01 <br />3. Field Data — Preservation: / / , y <br />J <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />Z 3 i <br />L e r <br />/-t <br />L t/ <br />1. Sample Type: l ) Water Soil Other (specify): <br />2. Analysis — Test series requested: <br />14 f:7 5 U s G / = ,e1 / a <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 />