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' ' COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i W= S 7 0 i <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Cation City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. 6 - Ij~ rl'VJ JD <br />Lab. No.(s) <br />Sample Date A-6113 Time <br />Collected By ,L2 U 6 *- <br />Field Custodian o6 Tenn C- ^ f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />%-V«VjL <br />((?? <br />vii -one Uesnnanon <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />WK 2 4�o I <br />c <br />E l A%% , ,, rrr <br />Sample Type: Air, - - -Water Soil <br />Analysis -�� es s requested: _T� We <br />3. Field Data - Preservalbain: <br />4. <br />5. <br />Other (specify): <br />I' y 'Z 5 -=j <br />6F A I' I iV(,);k -: tel , t Lk <br />Date analysis required by (if not Holding Time); <br />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 <br />QAC <br />) If NO, explain: <br />Date <br />Page 25 of 25 <br />