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l . , 111 SSC 1 <br />i t 11" MSC I I V U I I U U <br />F to of Ex <br />Akiefi.m <br />5 d itil... <br />List5.%1 <br />Q2:0 <br />T(2.8.e.lt, <br />C: P.O. Box 1759 S: <br />Cafion City, CO 81215 <br />Sample Loc./ID No. IV 4 L <br />Sample Date 9 -8 rune i '10 <br />Collected By Lo "Te"da f <br />Field Custodian go4 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 142 S25712 <br />QAC <br />P.O. Box 1750 N:. P.O. Box 709 <br />Cation City, CO 81215 Nncla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />< tv <br />E eo, 0,14 c. <br />2.393 ..141i ee.eek <br />zap g <br />, . z 0_ <br />Sample Type: Air Water Soil Other (specify): <br />Analysis β€” Test series requested: <br />3. Field Data β€” Preservation: 4. g. .?0 elaβ€ž,,,,j, 3 76 QC S s <br />r A/ .C*. ee.v 1.18 S s''' FA #4/ a 2 <br />2 Ativa <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 β€” Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page 30 of 30 <br />