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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11" S 25423 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Cnion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. -5 &J / Gv n <br />Sample Date / 9 -.o// Time ' 0 d <br />mo <br />Collected By 136 4 ! 42-?v?? ti f <br />Field Custodian 8 e et <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a.. <br />v <br />ucr vuwiw ucaunuuvu <br />- <br />y- <br />go C <br /> <br /> <br />• O ? <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: _ <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if <br />0.- tv not Cotter: <br />J <br />X393 St<lT C'rc'E'? /'?&..?i. <br />;a. <br />' Soil <br /> <br />Other (specify): <br />3. Field Data - Preservation: r7 9. 7 s <br />it INSQ (Ie-rr_/0 6 u.'f J4f.:? 0.5 <br />5t'4 -? 2" <br />4. <br />5. <br />Date analysis required by (if not Holding Time): . <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 13 of 20 <br />) and explain below. <br />