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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 3`, r s2847 t <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. S w G S <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Sample Date /0 - 6 - 5— Time / + 415— Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Collected By /.30‘ / PY7/7 e h f <br />Field Custodian 13 h 1"0 ti el a ✓� r <br />Delivered By <br />Received By <br />Date Recd. <br />' <br />Uesti <br />1. ILCL D <br />W11.0111; tna A M <br />2 s T <br />(6./6 <br />fr- .IE <br />1M <br />10;15 <br />i 20 <br />Z 393 $(. /* C r- r H /1•, �. <br />A ? <br />Time Recd. er <br />1. Sample Type: Air Waterer 5 Soil Other (specify): <br />/ <br />2. Analysis — Test series requested: G 4/e / <br />3. Field Data — Preservation: 1. P t. g /1/1 7 2'1 f A.. cj /66i/e,. S „ ., , <br />! T 1 <br />re D Z> L.. PA /1/1--'rl 2 � r71 <br />t <br />/i WA. •,v3 ? .,,..,,;, l7 5 L l/f' , O S L1/,�.///-4 5.1 7,> ,....,1 <br />Q . $ 1. 11 1c7 /V& (i/I 2.5 .-. . <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 18of18 <br />