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COTTER CORPORATION S SUBMITTAL AND TRACKING FORM <br />Moe <br />9 ple Submittal �.� S <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />vj.T ;-� <br />Sample Loc. /ID No. <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />r r <br />Sample Date Time <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />vu��ca <br />Vll�DILC LGALIIIiIUVII <br />va C <br />� U <br />Sample Type: Air Water Soil <br />Analysis - Test series requested:' •-e. t <br />Lab. No.(s) <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Other (specify): <br />3. Field Data - Preservatio— T -Cr t'' � C., I �)�. � <br />r 0 "'y I � � 4 L) ice•. —S — ` ). r' <br />4. <br />5. <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial { <br />COMMENTS - Explanation of noted items: <br />�3• Z-') <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 15 of 16 <br />