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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />12' S 25648 <br />Sample Submittal .C: P.O: Box 1750 S: AO. Box 1750 Ne P.O. Boa 700 <br />Cation City, CO 81215 Canon City, CO 8121S Nucla, CO 81424 <br />Sample LocJID No. Lab. No.(s) <br />Sample Date 746-2040V Time 9' V147 Date Data Entered <br />J? ??c <br />a . By <br />Collected By Data Entry <br />I <br />Field Custodian /So4- ? C4?.: Laboratory Destination if not Cotter: <br />i <br />I <br />Cotter Off-Site e Desttleatiion tr de4 ai e5 C <br />Delivered ByAST+aw1we .61 E)e 73' ?3 J 7? r eC LC h4--/ <br />Received-By 10E e_eI?JC <br />Date Recd. <br />Time Recd. Le e f <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis.- Test series requested: r4 6 Ae r <br />i <br />!I 3. Field Data - Preservation: R.. Y 7. G`" i-c -s <br />s e? /.tip a ° ` / e_,C.4 //w d 011j <br />r`?:; ?+? s_?Gr??'??!/o? ? s? , I?G• ?.?/?? SUS. s ;*-?.? <br />.,, analysis regored by (if not Holding Time): <br />5, Special handling conditions or other instructions: <br />6. In circumstances? if YES initial ( ) and explain below. <br />C. <br />COMMENTS - Explanation of noted items: <br />1 <br />( k if additional attachments. <br />. QA Review:: ? <br />gee ?; YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />. <br />of 29