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o er <br />- <br />- & <br />w <br />/2_ t1 <br />i `)-,<-; <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ::2 S 25782 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. _56.../ J 0 .5 Lab. No.(s) <br />Sample Date 5 fO 2o'f Time - /3 - 3S - Date Data Entered <br />Collected By Q /'�`','+�*✓G'✓r Data Entry By <br />Field Custodian igv 6 T « ti c. `7 Laboratory Destination if not Cotter: , <br />C tt Otf Site Destination 5 y I c 4 ` tic 4 r `' 5 / -. .� .. C- <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• -- �' Z d <br />!v S v r Lam/ r - <br />G �,., •i <br />1. Sample Type: Air Water f Soil Other (specify): <br />2. Analysis - Test series requested: C`.�ic�E' <br />3. Field Data - Preservation: T° /3.3 <br />,. '1 <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 />/1 7 q 7 <br />(9. 5 G /`4.t41' tJ 2, 5 - <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />aye 42 of 44 <br />