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1. - <br />- D <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal , 2 5 25764 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Date 5 . - > f/ Time O y Date Data Entered <br />Collected By /Sr7 .�+- r✓G..t. 1 Data Entry By <br />Field Custodian : "2 -� Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Off St ' t' <br />2. Analys est s q <br />3. Field Data - Preservation: r ^� 2. <br />Lab. No.(s) <br />e.7 r'.. (,� G. e ( . ,i c.. a <br />7J � } c. ✓_� A 4 // <br />f r P <br />1. Sample Type: Air Water ! Soil Other (specify): <br />is - T series re nested: <br />P r � c'... f",/ y. 3() z s r r:� a G / /7. Z ( S <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <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 ( ) If NO, explain: <br />QAC Date <br />c "1 <br />r K �j • r.� 2. f 2 <br />Page 14 of 20 <br />TA' C <br />