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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2 s26193 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 31215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. L. & e- , > w E r Z- Lab. No.(s) <br />Sample Date ,4 0 ? J Time 0 J Date Data Entered <br />Collected By x.0'1.- a,, el i1 Data Entry By <br />Field Custodian Laboratory Destination it not Cotter: <br />Delivered By 14 <br />Received By <br />Date Recd. <br />Time Recd. r r <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: 1-" ??. / <br />3. Field Data - Preservation: 7 oc / .9 n /' 1 00,017 1.a/ R S <br />oc? ?? O oC Ur <br />L 1•a <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? It YES Initial <br />COMMENTS - Explanation of noted items: <br />( ) Check it additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />) and explain below. <br />Page 35 of 36