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Sample LocJID No. <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal r:° s 2 S 6 5 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />S <br />Sample Date Y-6 - 2 ot/ Time / a- a 0 <br />Collected By 030 �' r��✓*✓ 7 <br />Field Custodian /3 . 4 �P.�••.✓d .a. <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Labol Destination if not Cotter: <br />i"/►��1 c ' Oi'-7 - Id.s L..C. <br />7 3 4. 3 SJt /7 <br />Cc s .• � t� yr_ g26 UZ <br />Time Recd. ` <br />1. Sample Type: Air Water f Soil Other (specify): <br />2. Analysis Test series requested: ( e e <br />3. Field Data - Preservation: f 7 . / f' P • g S ) A✓ c 2 4'7 te S � J - "- <br />k/-40 a vc.. 3. g 2 c.4 5 dii t ° o. A *Ale; 2. .5 .•-��" <br />Cfis I. 21' <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 />Page 39 of 43 <br />'.ptLCr <br />1111 11C311JMiHVM <br />06 <br />4..,40 <br />F <br />-`- <br />- - -- <br />. . <br />5 .'4 <br />% .g. <br />4r-io <br />h <br />Sample LocJID No. <br />Delivered By <br />Received By <br />Date Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal r:° s 2 S 6 5 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />S <br />Sample Date Y-6 - 2 ot/ Time / a- a 0 <br />Collected By 030 �' r��✓*✓ 7 <br />Field Custodian /3 . 4 �P.�••.✓d .a. <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Labol Destination if not Cotter: <br />i"/►��1 c ' Oi'-7 - Id.s L..C. <br />7 3 4. 3 SJt /7 <br />Cc s .• � t� yr_ g26 UZ <br />Time Recd. ` <br />1. Sample Type: Air Water f Soil Other (specify): <br />2. Analysis Test series requested: ( e e <br />3. Field Data - Preservation: f 7 . / f' P • g S ) A✓ c 2 4'7 te S � J - "- <br />k/-40 a vc.. 3. g 2 c.4 5 dii t ° o. A *Ale; 2. .5 .•-��" <br />Cfis I. 21' <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 />Page 39 of 43 <br />