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• <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal EIS S25233 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Callon City, CO 81215 Callon City, CO 81215 <br />Sample Loc./ID No. -S Li t( Lab. No.(s) <br />Sample Date A-1-I Time <br />Collected By a ) re..../." <br />Field Custodian A rp."...tie" <br />Cotter Off-Site Destination <br />Delivered By et a 4Y__.2A2. <br />Received By if) e ( /It <br />Date Recd. <br />Time Recd. /0 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />c tor c. <br />1353' Sc .1 e•-e.ek /44.„ <br />cp ) g2662._ <br />1 ,,fe <br />1. Sample Type: Air Water 7 Soil Other (specify): <br />2. Analysis - Test series requested: 7 4 / <br />3. Field Data - Preservation: 1' / 5 7S6 64-.0(2 g3 cji 1 <br />• fr Mie e0r4/1 / Aci c — L22 /- <br />/ fie? 4 2 a,.P /, 2 ) 7) <br />cat O. 5 Ze-rf e*V4 Zt <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( .) and explain below. <br />COMMENTS - Explanation of noted items: -et Gt.", 14 V go, arA ) / 2.3 - Cool <br />tite" ter / fil; Le le 4/.07 <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC • Date <br />Page 40 of 41 <br />