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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 112 S25696 <br />C: P.O. Box 1750 <br />Callon City, CO 81215 <br />Sample LocJID No. St <br />Sample Date L i' 6 -- .26// Time j 30 <br />Collected By 40 7:PA" 4 i4-4 Data Entry By <br />Field Custodian ao4 Laboratory Destination if not Cotter: <br />Cotter <br />.5 AL 46.elvs <br />/A f-vr/ <br />Delivered By 7 J 93 54,4 e • ele <br />7 <br />Received By <br />Date Recd. <br />V <br />• <br />Time Recd. <br />1. Sample Type: Air Water , Soil Other (specify): <br />2. Analysis - Test series requested: ( <br />3. Field Data - Preservation: r" <br />1 6 <br />r4,7 Z <br />, • • <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Ivy% Si . tO . • <br />7.9 ,#7.gi 269 4 ,5 4 11, - " - <br />7. <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 40 of 43 <br />ILILL ..,.......... <br />A44. <br />P: d E le <br />fedG <br />%Ibis <br />til E <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 112 S25696 <br />C: P.O. Box 1750 <br />Callon City, CO 81215 <br />Sample LocJID No. St <br />Sample Date L i' 6 -- .26// Time j 30 <br />Collected By 40 7:PA" 4 i4-4 Data Entry By <br />Field Custodian ao4 Laboratory Destination if not Cotter: <br />Cotter <br />.5 AL 46.elvs <br />/A f-vr/ <br />Delivered By 7 J 93 54,4 e • ele <br />7 <br />Received By <br />Date Recd. <br />V <br />• <br />Time Recd. <br />1. Sample Type: Air Water , Soil Other (specify): <br />2. Analysis - Test series requested: ( <br />3. Field Data - Preservation: r" <br />1 6 <br />r4,7 Z <br />, • • <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Ivy% Si . tO . • <br />7.9 ,#7.gi 269 4 ,5 4 11, - " - <br />7. <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 40 of 43 <br />