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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 26178 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Caflon City, C?O^ 81215 Caiion City, CO 81215 <br />Sample Loc./ID No. J (ILJ A 0 ? Lab. No.(s) <br />Sample Date W o Ti ) 3 On <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />IJULLCC Vii-auc aiwa?uauo/u <br />L 4 h <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1.G it <br />1. Sample Type: Air Water / , "Soil Other (specify): <br />2. Analysis - Test series requested: /"') CAO / - u f o XJ . I ) <br />tion: <br />3. Field Data - Preserv <br />a <br />it, t ?' ,' ,tiff L 7 , S J, ; of / L- ICA H A / d :z 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 38 of 44 <br />N: P.O. Box 700 <br />Nucla, CO 81424