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I _ <br />j COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM. <br />Sample Submittals S fi <br />-663 <br />i <br />C: P.O. Box 1750 S: P.O. Box 1150 N: P.O. Box 700 <br />I Cafaou City, Co 81215 Callon City, CO 81215 Nucla, CO $1424 <br />f <br />Sample LocJID No. J Lab. No.(s) <br />Sample Date 1- 2 9- 2 4 / Time 10:0$77 <br />Collected By 13 o l A.,ti,ve y 7. <br />Field Custodian . do > <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />/a.vaaer lJU-0sw a,caua...vu <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination If not Cotter: <br />3 CJ P P <br /> <br />Sample. Type: Air Water f Soil Other. (8.pecify): <br />Analysis - Test series requested: <br />3. Field Data - Preservation: <br />a 4Z *14 <br />4. Date analysis required by (if not Holding Time): <br />S. 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 />i QA Review: <br />i <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />I. <br />QAC ; Date , . <br />page 1f3-o '2U