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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal , :2 5 25783 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />4/' <br />Sample Loc. /ID No. $ 6 S' <br />Sample Date '/O -2 o "i Time / 'IS <br />Collected By , . :- <br />Field Custodian I ? d.4 7; 01../ C. z ` 1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />' its, A , S ',,.e, c <br />1 f F ) <br />1. Sample Type: Air Water <br />/ / Soil Other (specify): <br />2. Analysis - Test series requested: . ,. -, <br />3. Field Data - Preservation: T n� / 3. /7 # 7 g0 ( _ .. �' 3 6 S— e. f c <br />0.5 Z 7 NIV0 2 S , .�. P <br />T7 j. a f <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 />ayC 43 u <br />1,,u«er <br />v11 .11V LGD1.1LA.aVu <br />i�'' <br />4 ( K ; 4..1.' <br />✓ <br />r � // <br />t ( ': � , <br />[AZT L' <br />,. <br />• <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal , :2 5 25783 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />4/' <br />Sample Loc. /ID No. $ 6 S' <br />Sample Date '/O -2 o "i Time / 'IS <br />Collected By , . :- <br />Field Custodian I ? d.4 7; 01../ C. z ` 1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />' its, A , S ',,.e, c <br />1 f F ) <br />1. Sample Type: Air Water <br />/ / Soil Other (specify): <br />2. Analysis - Test series requested: . ,. -, <br />3. Field Data - Preservation: T n� / 3. /7 # 7 g0 ( _ .. �' 3 6 S— e. f c <br />0.5 Z 7 NIV0 2 S , .�. P <br />T7 j. a f <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 />ayC 43 u <br />