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wr,w. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal NO S 11483 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Callon City, CO 81215 Nucia, CO 81424 <br />Sample LocJID No. -g 6cl C' Lab. No.(s) <br />Sample Date Z? -2 0i 0 Time v Date Data Entered <br />Collected By c Data Entry By <br />Field Custodian _ 1 r ..,. e .7 Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />?.ouc?. <br />< Vll'O1LG LCSL3LIit1V4/ <br />t,; b <br /> ?° CSL <br />.3 <br /> <br /> <br /> <br /> <br /> i <br />r <br /> A-1 <br />S. <br />? o. <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: C de <br />3. Field Data - Preservation: W /y 7,67 e,-, 1?0 <br />?c S -t s ` <br />v? •?s e rd .,d, ID, rr s O 5 ^ L IWO-, 7. S^ <br />4. Date analysis required by (if not Holding Time): _ <br />5. Special handling conditions or other instructions: <br />b. 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 19 of 20 <br />