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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal I-111101- C: P.O. Box 1750 S: P.O. Box 1750 <br />Cation City, CO 81215 Caron City, CO 81215 <br />Sample LocJID No. rT Lab. No.(s) - <br />Sample Date , /p 201/ Ttme- ?:20 Date Data Entered <br />Collected By Data Entry By <br />Field Custodian /Sa f?".?r?Gr Laboratory Destination if not Cott r: <br />o+ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />Z. <br />3. <br />Cotter Vii' to es na on . <br />r c <br /> <br /> u <br /> <br />.v r <br />Sample Type: Air Water Soli Other (specify): <br />Analysis - Test series requested:- ' <br />Field Data - Preservation: -55O S-tSr <br />/' • G `, y • [/?? <br />-.s:;,r?..j?••.i 0...?rY_ 7_ X ?G ?G! ?l S' ?` ? ? 1 /T --? JY??'Z ? +L:/If?tr <br />2 L ll? <br />Analysis re#red by (if not Holding Time): <br />4 5. Specat handling conditions or other instructions: <br />Iavalidpting .circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />r <br />deck K additional attachments. <br />;..QA Review: <br />YES ( ) NO ( } If NO, explain: <br />e valid? <br />N: P.O. Box 700 <br />Nucla; CO 81424.