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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C:. P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />CaOon City, CO 81215 CaOon City, CO 81215 Nucla, CO 81424 <br />Sample Lee./ID No. ?,?,,00- Lab. No.(s) <br />Sample Date- Time 0 S <br />Collected By J&n lac, ..r ? - <br />Field Custodian 49,d 4, :nO.v... e <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water -> <br />2. Analysis - Test series. requested: <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />C iv t?:? ? -cy. ? ? o ? 4 fvi,r ps ?i? C . . <br />A-4/4 26100-.Z <br />d? <br />Soil Other (specify): <br />j 3. Field Data -Preservation: K. . Zr.. Gr Y " ° ` <br />s. . alydis required by (if not Holding Time): <br />S. 8 t Ukandling conditions or other instructions: <br />6. Invalidating` to ; tances? If YES initial { ) and explain below. . <br />4M'MENTS - Explanatlon of noted items: <br />i <br />.Y. -:- ?,. ? ? .K ¢-:<... s?:.?is ?. .. -:. sN ms's-•;-;;,; ?i.n..?a?i'?3Y.?•.v. .-.?.?.-e:a?a. ??:+? -.« ?i.'??e3?iwa-<.....?,:_. .+?r- L.t.. i??c•' .?..?.c:.v?i7