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Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal � S 25758 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. S /3 /'L Lab. No.(s) <br />Sample Date 9-19.-2 Time / V'1 5 Date Data Entered <br />Collected By /.� v 4 ��NN c A ., t Data Entry By <br />Field Custodian /4 < 7 ptis✓4 ti � Laboratory Destination if not Cotter: <br />Cotter Off Site Destination v t <br />Delivered By Z 3 9? j- i/ r le c p 4 t . y . <br />Received By S _, � £i " 7 (/ <br />1. Sample Type: Air <br />2. Analysis — Test series requested: C r , ,-1, / <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />t: 4 <br />Water Soil Other (specify): <br />,/ <br />3. Field Data — Preservation: y ' I 7 0 .�. 2 9 3 �, s <br />Yi/v se P ti 1 1.92 u L /z s ` (7 5 / / // A//1'4 <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 <br />Date <br />Page 37 of 38 <br />G .; /, <br />i. <br />? <br />t l G . / <br />�y�� <br />do <br />.. .— <br />7 ' <br />-9)04 <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal � S 25758 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. S /3 /'L Lab. No.(s) <br />Sample Date 9-19.-2 Time / V'1 5 Date Data Entered <br />Collected By /.� v 4 ��NN c A ., t Data Entry By <br />Field Custodian /4 < 7 ptis✓4 ti � Laboratory Destination if not Cotter: <br />Cotter Off Site Destination v t <br />Delivered By Z 3 9? j- i/ r le c p 4 t . y . <br />Received By S _, � £i " 7 (/ <br />1. Sample Type: Air <br />2. Analysis — Test series requested: C r , ,-1, / <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />t: 4 <br />Water Soil Other (specify): <br />,/ <br />3. Field Data — Preservation: y ' I 7 0 .�. 2 9 3 �, s <br />Yi/v se P ti 1 1.92 u L /z s ` (7 5 / / // A//1'4 <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 <br />Date <br />Page 37 of 38 <br />