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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal P,? R15364 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. O's - cl)`l /A Lab. No.(s) <br />Sample Date ?2 -/O Time C0-P° sI tlt Date Data Entered <br />Collected By Data Entry By ; i <br />Field Custodian Zo2 e-^1e -? Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />J? -?a.uawr V11?Jl?G LGJ?34PNVLL <br /> <br /> <br /> <br />1. Sample Type: Air Water <br />2. Analysis- Test series requested: r <br />Other (specify): <br />3. Field Data - Preservation: 7'0- <br />-1) 5 6 <br />16 2 v t, s J-t, '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: i / 3 3c) ;) Z Z ` w (- C ? = ° ' <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) Ir NO, explain: <br />QAC <br />?4 % <br />Soil <br />Date <br /> <br />Page 8 of 9