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Delivered By
<br />Received By
<br />Date Recd.
<br />Time Recd.
<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
<br />C: P.O. Box 1750 S:
<br />Cafion City, CO 81215
<br />Sample Date -/O-2 Q/l Time /0 y©
<br />Collected By A/4 z; 1, "✓e 4,
<br />Field Custodian ..do f Pn ,�, C :.
<br />Sample Loc. /ID No. 4 •*^.
<br />Sample Submittal
<br />1. Sample Type: Air
<br />2. Analysis — Test series requested:
<br />) Check if additional attachments.
<br />QA Review:
<br />Sample valid? YES ( ) NO (
<br />QAC
<br />;12 S25837
<br />P.O. Box 1750 N: P.O. Box 700
<br />Cafion City, CO 81215 Nucla, CO 81424
<br />Lab. No.(s)
<br />Date Data Entered
<br />Data Entry By
<br />Laboratory Destination if not Cotter:
<br />7 "- F'� �(^ /. o.-. 7r, �t s 7 ., c -
<br />/t . 3 J Oil /
<br />02
<br />Water 6
<br />? Soil Other (specify):
<br />2 .
<br />3. Field Data — Preservation: J0. q f / / (?),‘,0( �, ∎ r rrs.•l s , u`--
<br />[� ' J 0
<br />5 Q. r. rl f7 c.. `` `�[! 0 J J r
<br />/ a /c ' '/1%f1. 2 a.-09 , /GF, / e C(->1 / A/o U ,
<br />2 G G/ i / G. £'7-,4' 2 SC 5 .x-.,i
<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: - 1 lt, . �, r f,�, �/Q f " 2 .7 ( 2 , ) ,.. )
<br />? / at, rif. f //diue. 4/7
<br />) If NO, explain:
<br />Date
<br />Page 2flof20
<br />/- 1 ! 1 0/#
<br />0 0
<br />e
<br />.,...,
<br />1
<br />6 SO
<br />Delivered By
<br />Received By
<br />Date Recd.
<br />Time Recd.
<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
<br />C: P.O. Box 1750 S:
<br />Cafion City, CO 81215
<br />Sample Date -/O-2 Q/l Time /0 y©
<br />Collected By A/4 z; 1, "✓e 4,
<br />Field Custodian ..do f Pn ,�, C :.
<br />Sample Loc. /ID No. 4 •*^.
<br />Sample Submittal
<br />1. Sample Type: Air
<br />2. Analysis — Test series requested:
<br />) Check if additional attachments.
<br />QA Review:
<br />Sample valid? YES ( ) NO (
<br />QAC
<br />;12 S25837
<br />P.O. Box 1750 N: P.O. Box 700
<br />Cafion City, CO 81215 Nucla, CO 81424
<br />Lab. No.(s)
<br />Date Data Entered
<br />Data Entry By
<br />Laboratory Destination if not Cotter:
<br />7 "- F'� �(^ /. o.-. 7r, �t s 7 ., c -
<br />/t . 3 J Oil /
<br />02
<br />Water 6
<br />? Soil Other (specify):
<br />2 .
<br />3. Field Data — Preservation: J0. q f / / (?),‘,0( �, ∎ r rrs.•l s , u`--
<br />[� ' J 0
<br />5 Q. r. rl f7 c.. `` `�[! 0 J J r
<br />/ a /c ' '/1%f1. 2 a.-09 , /GF, / e C(->1 / A/o U ,
<br />2 G G/ i / G. £'7-,4' 2 SC 5 .x-.,i
<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: - 1 lt, . �, r f,�, �/Q f " 2 .7 ( 2 , ) ,.. )
<br />? / at, rif. f //diue. 4/7
<br />) If NO, explain:
<br />Date
<br />Page 2flof20
<br />
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