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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal NL S2$437 <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. moi, ol .t t i! fti f <br />Sample Date Ji' - / > Time / 0 <br />Collected By i5,, ren n 4 <br />Field Custodian 6 TPN c „ _f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />M <br />.,.,«V. A1 - <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />imor 3, / £ Cod' C ce'sr! .x C <br />7 1. 9 3 Sc /f i <br />�srPr) Gvy g2‘0/ <br />1. Sample Type: Air Water J Soil Other (specify): <br />2. Analysis - Test series requested: j a► S f e Z+ <br />3. Field Data - Preservation: 1-#4,- 1 k . 4 . Al 7. OZ fpm, Z.5' S'S- . cep"— S �C <br />A° rf1;'$ 174 1'f3Nti) pde.k 41.J/ gs— .,...� <br />rr,i roc, �J <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 7 of 7 <br />Site Destination <br />!3, .6 1 <br />P <br />Ar <br />Illrtr <br />lr <br />1 C <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />imor 3, / £ Cod' C ce'sr! .x C <br />7 1. 9 3 Sc /f i <br />�srPr) Gvy g2‘0/ <br />1. Sample Type: Air Water J Soil Other (specify): <br />2. Analysis - Test series requested: j a► S f e Z+ <br />3. Field Data - Preservation: 1-#4,- 1 k . 4 . Al 7. OZ fpm, Z.5' S'S- . cep"— S �C <br />A° rf1;'$ 174 1'f3Nti) pde.k 41.J/ gs— .,...� <br />rr,i roc, �J <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 7 of 7 <br />