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Sample Loc. /ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cafion City, CO 81215 Canon City, CO 81215 <br />Sample Date 6 2, 4 be ,q :.2 S <br />Collected By i 'a ' e u f✓ <br />Field Custodian J✓ <br />Cotter Off -Site Destination <br />Delivered By 60 4 /84 244 C..20/...:Se E � r <br />a— <br />Received By f" 1� <br />Date Recd. �" /l :3 <br />/ <br />Time Recd. (6.6 ..i.c.c..._ y 44 <br />1. Sample Type: Air <br />: s25824 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />s r- <br />Water C? Soil Other (specify): <br />2. Analysis — Test series requested: !.� 6 42 <br />3. Field Data — Preservation: re- /6. rT /. / 3 (4)AA-; ft' gt l./ ..c zS <br />1 ,71 1 _ L l . 3/ L a/" ,(/ ) ' ( 5 ) <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 Date <br />Page 71•inf 21 <br />