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't. <br />'t. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />• Sample Submittal f ._ <br />C:. P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Cason City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. A - ;? Lab. No.(s) <br />Sample Date 1 '; 4 _) / Time <br />'???"?'``?'` r <br />Collected By <br />Pir"r? <br />Field Custodian 910,447 <br />Delivered By <br />Received By <br />Date Recd. <br />_??ue•Recd. <br />I..VLLCa" vaa•ua?c a?ca uL?a.v.a <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />ory Destination if not Cotter: <br />Laborat <br />Fleo Ole, <br />2- _3 -51 1 <br /> <br />4hL <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: + <br />v ?- <br />3. Field Data - Preservation: ' Ay 7/7 O <br />j I`?c.r .? ?' Lf" :.? ?:: ;?`, ?i? ?' ?+.? 1,??•f -? 1 ? ~ ?? .e l;t;?%?.? ? t? .? ; .a t,.s.:- . f •a ?^ a:... +G ? ..?' ? '?.?1?"t.r? <br />iv Ar /01 <br />f F LX7 ?c°`.?'T +'??? ?? 3ar 3 y?•a..e; ,, f <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 Date <br />