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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />s21448 <br />S: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. lin /1 <br />Sample Date /0 -' - / `' Time S 3 d <br />Collected By &C T Pr!/i a n <br />Field Custodian /..4 Te,NpG n r <br />Delivered By <br />Received By <br />Date Recd. <br />Time .Recd. <br />%.uIIcl <br />va■-onc LLcauuaswu <br />�, <br />F <br />n1 <br />It feta, <br />(0 ;0Z <br />1. Sample Type: Air <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) - <br />Date Data Entered <br />Data Entry By - - <br />Laboratory Destination if not Cotter: <br />2 393 .Sti/f C'rteK fi..._.y. <br />(�SfP. , Gv7. ZloZ <br />Water Soil Other (specify): <br />2. Analysis - Test series requested: Ta /t <br />3. Field Data - Preservation: !c'c I8. O hi 6 , 9 7 ZkyJ <br />°Aro tic,. •136 it/go /�vM� / c Cl'i 5� <br />o . 2 s " L ("f/= ft I-/7 re Po • tor, <br />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 <br />Date <br />Page 7 of 8 <br />