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Ln <br />COTTER CORPORATION SAMPLE S MITTAL AND TRACHIN OR1� <br />St uQtA ,: S TT <br />Vi <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Callon City; CO 81215 Nacla, CO 81424 <br />Sample Loc./ID No. <br />Sample Date i `� Time 7 ` <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />. f. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1. Sample Type: Air Water l_ Soil Other (specify): <br />2. Analysis - Test series requested: ' r1 <br />3. Field Data -Preservation: T �- i .� r '% 5 y t ell <br />+ <br />- <br />r <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />f. Invalidating circumstances? U YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />) Check it additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) U NO, explain: <br />QAC ; Date 4. <br />Page 8 of 8 <br />