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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1'4E s2$522 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />CISJIo',I/ <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. /41 i A e A ¢ t ,.// <br />Sample Date i / ' / 7 "/ `, Time I%. O <br />Collected By 6047 47 Tpdr i Q n - <br />Field Custodian ,Qr 7o r1 K r n f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />F. E��jLJt �Cr4..C/4-, s Cr <br />2.353 • Sri(1,4>e Ir be,/, <br />ea ct o., / 4/1". <br />/6 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: ra 4/e IA <br />3. Field Data - Preservation: r- C / S, '1 /4///7.00 (' ,tJ. 2s L 0 <br />OQ 14, Iuc , /26 (r 3 `i ) <br />l �u-p ,,J, 9rr <br />0, 1 , d uf,�3 N, PO, 4..- To c- <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 8 <br />4011.011C 1/CSLLUMLLLVU <br />//�LULLCI <br />F� I V <br />n <br />= p <br />Lac..... EXwa <br />A t- 1t5 <br />tIDS <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />F. E��jLJt �Cr4..C/4-, s Cr <br />2.353 • Sri(1,4>e Ir be,/, <br />ea ct o., / 4/1". <br />/6 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: ra 4/e IA <br />3. Field Data - Preservation: r- C / S, '1 /4///7.00 (' ,tJ. 2s L 0 <br />OQ 14, Iuc , /26 (r 3 `i ) <br />l �u-p ,,J, 9rr <br />0, 1 , d uf,�3 N, PO, 4..- To c- <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 8 <br />