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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 25343 <br />i ti _ S <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date > 71 • , / Time 9 ') - 0 <br />Collected By ).� 4. G • T <br />1. Sample Type: Air Water <br />2. Analysis — Test series requested: 7 4 7 e / <br />6. Invalidating circumstances? If YES initial ( <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nncla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Field Custodian ,P h rp� -"�+%c -. 7` Laboratory Destination if not Cotter: <br />Cotter Off - Si t e Des • , r c � L ` • ' • <br />J <br />Delivered By <br />� /� 3 j s <br />_,,'.. 7/ 1 / y. <br />Received By ( 6 r l 14/ (7, C` (, O <br />Date Recd. <br />Time Recd. <br />n <br />Soil Other (specify): <br />°`C 9 �� -y, g (• , ,'- 22'3 <br />f, <br />3. Field Data — Preservation: o . � ' � <br />1 !�1 7 5 4 , <br />5 - i . 0 <br />.r .�// L /, f, // c( -1) , <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />COMMENTS — Explanation of noted items: <br />( y) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Pago 31 of 38 <br />.0.7 <br />r <br />v._..„-....... <br />Li <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 25343 <br />i ti _ S <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. <br />Sample Date > 71 • , / Time 9 ') - 0 <br />Collected By ).� 4. G • T <br />1. Sample Type: Air Water <br />2. Analysis — Test series requested: 7 4 7 e / <br />6. Invalidating circumstances? If YES initial ( <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nncla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Field Custodian ,P h rp� -"�+%c -. 7` Laboratory Destination if not Cotter: <br />Cotter Off - Si t e Des • , r c � L ` • ' • <br />J <br />Delivered By <br />� /� 3 j s <br />_,,'.. 7/ 1 / y. <br />Received By ( 6 r l 14/ (7, C` (, O <br />Date Recd. <br />Time Recd. <br />n <br />Soil Other (specify): <br />°`C 9 �� -y, g (• , ,'- 22'3 <br />f, <br />3. Field Data — Preservation: o . � ' � <br />1 !�1 7 5 4 , <br />5 - i . 0 <br />.r .�// L /, f, // c( -1) , <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />COMMENTS — Explanation of noted items: <br />( y) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Pago 31 of 38 <br />