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Sample LocJID No. <br />5. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Cation City, CO 81215 <br />SWA PH <br />Sample Date 9 , � t Time :S - O <br />Collected By /.7 0 4 1.n✓w✓ G <br />Field Custodian £ O 77o.4./.c/ c .. <br />Cotter Off -Site Destination <br />Delivered By 13 oh ft' �* relief ex 7 33 Y 3 S cIT (: e .e k /�}w , <br />Received By f:P d ,- ><:iL�f 1 4 c Sp 4 i 1 (,/)' . Sj 14 U 2 <br />Date Recd. ( 4t5.1‘ °S 0 [ . <br />Time Recd. Q c �,.,e° s <br />c°oU <br />1. Sample Type: Air Water 3 Soil Other (specify): <br />2. Analysis - Test series requested: C ocJ'Je. 3 <br />3. Field Data - Preservation: 7 p4 /. 8 ,, ,il . yo ..i,9. 3 9 4 4s S 4 .4 <br />, e 2 . ©s S s - °` / G f,4 h'iria3 �•• •�, <br />-z - 1 /="r4 HA4 le <br />4. Date analysis required by (if not Holding. Time): <br />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 ( <br />QAC <br />NZ 5 ? 1 <br />P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not. Cotter: o <br />)`'''' If NO, explain: <br />Date <br />