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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ? S .?! <br />C: P.O: Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S6CI 9 /24 Lab. No.(s) <br />Sample Date Time <br />Collected By <br />Field Custodian A,, e' -?. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />%.uaILcr vu-OUC IMMIJUMMU <br /> r <br />'r :ej <br /> r <br /> <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: r <br />Other (specify): <br />3. Field Data - Preservation: <br />4. <br />5. <br />04- •v cc <br /> <br />X79 <br />• C L <br />:? S Z S <br />1 L G/ /// fib 'Orr S i?* .U e2 5 " L G/? 7/71 C1/! <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />Check if additional attachments. <br />QA Review: <br />Sample valid? YES <br />QAC <br />) NO ( ) If NO, explain: <br />) and explain below. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cootter: <br />tiG. <br />2793 '--r l! /`f l?y <br />?r ?7 <br />')-t <br />Soil <br />Date <br />-,....-.?'?.»..?._.._ -?b_ .:.?-:?. •-_.. .. _,,:.. _.?.h...::_.?.:., . ..:.w :d'?--•y.-?.-.w.._r-.- _ _ `'m-- ?..fse..?.?.a1?.ri _.??--i•....ak?-.,.?..?v4:r-?c.r?