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• COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal W.! S25707 <br />C: P.O. Box 1750 <br />Casson City, CO 81215 <br />Sample LocJID No. J <br />Sample Date yr /2 -2 Df! Time J3. 0 <br />Collected By . ig o � •w",e <br />Field Custodian /34 f:;/"Wes...✓ <br />Cotter Off-Sil Destination <br />Delivered By 44114 Itaelv <br />Received By . . ��.- <br />Date Recd. <br />Time Reed. <br />6. . 'Invalidating circumstances? If YES initial ( <br />COMMIS ` Explanation of noted items: <br />QAC <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 D estination if not <br />0 .4•4 0 0j,e Lc toe ct <br />23 93 ScA4 t <br />41 ' ,.r 01 �•.. Y. <br />1. Sample Type: Alr Water / Soil Other (specify): <br />2. Analysis -- 1st series requested: . die <br />3. Field Data Preservation: ! 4 7 6 e p n 9. /A CI 3 a 3 - C, r t "' <br />5/ /.Y <br />4. Date analysis required: by. (if not Holding Time): <br />5. Spedal handling conditions or other instructions: <br />. . ) and explain below. <br />( • ) Check if additiomd attachments. <br />QA Review: <br />Sample valid? YES ( ):. NO ( ) If NO, explain: <br />Date <br />Cotter: <br />rO e'r 0 .5 <br />27_6 02. <br />Page 18 of 20 <br />