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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal N!! s21666 <br />C: P.O. Box 1750 Ss P. <br />Cason City, CO 81215 Ca <br />Sample LacJID No. - ?? <br />O. Box 1150 <br />bon City, CO 81215 <br />Sample Date Time 05 <br />Collected By 6 • <br />Field Custodian 404. Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />l.uttcjr %FJLI- Sow M E WEI <br />Lt <br /> <br />Q? <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: t <br />N• P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination ii// not Cotter: <br />+?? a i?t)iafoiitS c. <br />73 43 S CiPVr kv A., 9r. <br />9'7-6 02 <br />?- <br />visor <br />w <br />Soil Other (specify): <br />? ° L .fir _ e •r <br />3. Field Data - Preservation: 5?.. 0 // 2 -7 S <br />J* 111V S L" di-F <br />4. Date analysis required by (if not Holding Time): <br />5. Special l[andling 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 ( ) Ii NQ, explain: <br />1 <br />QAC D