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1. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal N ! S 2 S 326 <br />C: P.O. Box 1750. S: <br />Cafion City, CO 81215 <br />Sample Loc./ID No. S 141,4 (J t✓ <br />Sample Date ; - 7- 2 OU Ti 9,o 0 <br />Collected By , v rt. Am., G .01 <br />Field Custodian. 406 l •V.vC <br />Cotter Off -Site Destination <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />2. <br />P.O Box 1750 N: P.O. Box 700 <br />Canton City, CO 81215 Nacla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />F .vCrki/ Lc4o foci " ... ., <br />2 3 9 3 Sc.. . jI / 6y, k. t /4" <br />Se. 4,ty, g z 6 a 2, <br />Water Soil <br />I Soil Other (specify): <br />G' <br />/ <br />Analysis — Test series requested: / / <br />Sample Type: Air <br />3. Field Data — Preserva on: T 9 . 7 f r 7 43 ^icy Z y 7 +.r S a} C <br />r /rv a .,d 2. - i 5"L 5 4.4 V 4,S i. 11F ,4 1A4 C 2_S <br />1eFy//4ivl0 Ao , /1. P f.ZS 6Gl fl1"O 25 <br />1 t° toe Z Ui 4 A .Sa 5 "'- -�-� .�' � 4' 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 n o t e d items: f t /tee' ccs • t 4 t/ tee) S i - r +1! i 2 . <br />( )1) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 33 of 41 <br />