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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ??_° S 25555 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Caf[on City, CO 81215 Nucla,. CO 81424 <br />Sample LocJID No.Lab. No.(s) <br />Sample Date J-.2 S: -20/1 Time 13 XO <br />Collected By X 1?ivw/E <br />Field Custodian ' Ao ,; ,_ov a24- <br />Delivered By <br />Received By <br />Date. Recd. <br />Time Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cott <br />P-11 Of <br />44 <br />3 tC <br />..z 3 Pr ..Az za 9A <br />o <br />h+ e? <br />at <br />Soil Other (specify): <br />{,.V ILCI llllh7l?C LC6 NlliNVl[ <br /> <br /> <br />? • 11 r' ?-1f• <br />16 co <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: <br />4. <br />5. <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( <br />.. QAC <br />If NO, explain: -- <br />Date <br />Page 36 6f39 <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: