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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2S25401 <br />C: P.O. Boa 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Canon City, CO 81215 Nucle, CO 81424 <br />Sample LocJID No. S (4/ - A tv <br />Sample Date 7 e-?f Z,011-Tine <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />\.VL?GC Will-aim ARLMLILANALIUM <br />r <br /> <br /> <br />q' t3 1t2 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination If not Cotter: <br />'e <br />tC,.'" <br />o <br />1. Sample Type: Air Water ? Soil Other (specify): <br />2. Analysis - Test series requested: • A" f / <br />3. Field Data - Preservation: T - 19-7 7 7. <br />r (Vi <br />l L / - <br />?'_ t? /l <br />A (\ ,2 •? S L " <br />L /-j J4 r,/../ QA/ <br />4. Dale analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />b. 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 27 of 29