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.. ..T. . gq-;p.rr.. .. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal NO S 2 59 2 9 <br />C: P.O. Box 1754 S: P.O. Box 1150 N: P.O. Box 700 <br />Callon City, CO 81215 Callon City, CO 81215 Nucia, CO. 91424 <br />Sample LocJID No. <br />/-? Lab. No.(s) <br />Sample Date 7 '2 D?? Time •? a <br />Collected By Ad K12A <br />Field Custodian ? 4d f / e A.., dy Ott Site Destination <br />Delimed By <br />Received By . <br />Date Reed. <br />Time Recd. <br />1. <br />2. <br />3. <br />Cotter ?` <br /> O \? <br /> <br /> <br />Date Data. Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />p orc vii S <br />'Z ro C7 ;I- <br />a? ~ <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - .Test series r equested: C -?? rte' e <br />Field Data - <br />ri,.rs %e. <br />Nod /+. <br />jac" 2 14 0 <br />?. -3. /B t.C-o 4,;W,-r 1- -5- L <br /> <br />T <br />6f. <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 additioul attachments. . <br />QA Review: <br />Sample valid? YES { ) NO ( ) . If NO, explain: <br />QAC Date <br />w <br />= - --- -._ - 35 3-3 . -= - <br />