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C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. 5Gpn fa " Lab. No.(s) <br />Sample Date S -,Z‘-244/ lime // 3 d <br />Collected By eg os Tp,. -,✓ Q 4/7 <br />Field Custodian L?, �14 a A/ # <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />2. Analysis - Test series requested: �4 4 /' �- <br />: 525771 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />k ,., Q.S. LG U. ( y s t 4. <br />7 g 2 3 sdt 7: /<. /141,. <br />.S, A j LJy I? Z 6 '2 <br />Other (specify): <br />3. Field Data - Preservation: l'" V . / 8 Cen ,.,1 efJ i <br />Cs ., a1 2 <br />z:. <br />/ U / G A fj',f0 Z 1 / / /�it.I/�� ///f/d o r ` 7 LGf• <br />/G efAH .S y 5 <br />4. Date analysis rewired 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 />Pogo 20 of 20 <br /><.VLLVA <br />vll -J1LC UVULA UUUU <br />/� <br />-- <br />,. / <br />k <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. 5Gpn fa " Lab. No.(s) <br />Sample Date S -,Z‘-244/ lime // 3 d <br />Collected By eg os Tp,. -,✓ Q 4/7 <br />Field Custodian L?, �14 a A/ # <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />2. Analysis - Test series requested: �4 4 /' �- <br />: 525771 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />k ,., Q.S. LG U. ( y s t 4. <br />7 g 2 3 sdt 7: /<. /141,. <br />.S, A j LJy I? Z 6 '2 <br />Other (specify): <br />3. Field Data - Preservation: l'" V . / 8 Cen ,.,1 efJ i <br />Cs ., a1 2 <br />z:. <br />/ U / G A fj',f0 Z 1 / / /�it.I/�� ///f/d o r ` 7 LGf• <br />/G efAH .S y 5 <br />4. Date analysis rewired 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 />Pogo 20 of 20 <br />