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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. Al kJ D O <br />S: <br />s28524 <br />P.D. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Date // " / 7 - S Time <br />Collected By /3 .> 4 1 o,► rrc <br />Field Custodian ib / .+ N ^ r <br />Delivered By <br />Received By <br />Date Recd. <br />1. <br />2. <br />Sample Type: Air Water Jf <br />Soil Other (specify): <br />Analysis - Test series requested: 7; b it Z <br />Time Recd. <br />Py:. <br />4V 1 Mr <br />vi I. 1,72 IV L.Gif“ua..w.. <br />s'., <br />I, <br />r <br />u}1R15 <br />1I 05 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />en r, Lc. 6 to, / <br />?3 /f re/�/ //uy <br />:te• j to/ t� Z bb/ <br />3. Field Data - Preservation: T "'- 9. 7 // Ai 7 / 5- (' 1j. 3 71 a_ <br />ro.,3 F. e, 3.,3 d. cr -°C.z s �DTA O �7 U o-�✓ c. A 0.5195 <br />1 �/9 <br />0.2. C G fAti/t/03 2/gl /G of/9 /`/4/03 2 d <br />o, S L LQ I - A /17 ray 2 . 1 �^ <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 13 of 17 <br />