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5 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal t y a S 2 5 5 T 2 <br />C: P.O. Box 1750 S: P.O. Box 1750 N:- P.O. Box 700 <br />Callon City, CO 81215 Callon City, CO 91215 Nucla, CO 81424 <br />Sample Loc./ID No. (.9/ )3 P L <br />Sample Date S "?U/?Zgme j ?/ 5 ?- <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />P/ ?/G u?/ f <br />3 93 a,?' C'r p c ,? <br /> <br />a.uaacr via-011M LcaHIIiilYu <br />A 0Z <br /> <br /> UL <br /> c <br />1. Sample Type: Air Water Soil Other (specify): . <br />2. Analysis - Test series requested: ?c <br />3. Field Data - Preservation: <br />4. <br />5. <br />b. 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 ( ) If NO,. explain: <br /> <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: