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w -w <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal N,2 s 2SA37 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Callon City, CO 81215 <br />Sample Loc./ID No. --!7 64-1 Lab. No.(s) _____ <br />Sample Date JJ -18'.Z 2 /2 Time <br />Collected ByP-?-.?- <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a,,v?ws vu-aur urnuuauuu <br /> tie <br /> - <br />CQ <br />Iv 2A kc?) S?f= <br />O'. O <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />I S <br />1. Sample Type: Air Water -?/_ y Soil Other (specify): <br />2. Analysis - Test series requested: _,TG 6/1- t <br />v? <br />3. Field Data - Preservation: !? 5 ~ G• 5 r <br />U r,4 HN G) 2 ,. I ('Y if JL 1//= %i, SC?G 4 <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 { ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( X ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC <br />Date <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Page 28 of 30