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r <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ; S 25189 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample LocAD No. G/ 14 Lab. No.(s) <br />Sample Date 9 ' 9 e ! . Time 9 1 S Date Data Entered <br />Collected B l -• "? <br />y (= •. -.? -•• ?: ? Data Entry By <br />Field Custodian Laboratory Destination U not Cotter: <br />Delivered By <br />Received By <br />Date Reed. <br />Time Recd. <br />a.vasar v(l0119 IMMUiuvu <br /> <br /> <br /> <br /> <br />G. PO o.1 <br />r? ?r w... <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: T,- L /c- / <br />3. Field Data - Preservation: 1 z;-_ i ;1L. 3 .., & 7 .7, a r <br />I lye; <br />i <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 it additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC <br />Date <br />- - PAg8.31_Qt.36_..._..-._._._._