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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11) S 2.539 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canou City, CO 81215 Nucla, CO 81424 <br />Sample Lac./ID No. ScC/ 0-S Lab. No.(s) <br />Sample Date /I- 4q " Zola Time, 13 Date Data Entered <br />Collected By)-? . c Data Entry By <br />Field Custodian Laboratory Destination iC not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water _L Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: -X U r• O ?S .; • r <br />/i,- S P P,, -'/ 4.58 , %' ?. S ? ",*A /Y /f/0 -r ;z <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 if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 36 of 40