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Sample Loc. /ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .2 S25338 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />0/4 sTiz <br />Sample Date S - 19 - 20 // Time ? • I /0 Date Data Entered <br />re <br />Collected By 11 D S .✓,✓ c ..I. 74 Data Entry By <br />Field Custodian /So I_, r V..V .. r Laboratory Destination if not Cotter: <br />Cotter Off - S to Destination -A. r' . s_ / c �� .� f <br />c. / 0- / ,s. 1,, c <br />Delivered By 2 ? S ? • s c; / f t'�� ." 4' 4,w//. <br />Received By r r- , `..- /,0/j" ',-, 1 ( O Z. <br />Date Recd. <br />Time Recd. ■ <br />/ t, <br />1. Sample Type: Air Water ff Soil Other (specify): <br />2. Analysis - Test series requested: 7-4 4 / / 4/ 2 <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />3. Field Data - Preservation: r; <br />-a ..: <br />�5 <br />i nv t e c" � t is� / . / 1 7 " c.� / 3 , d YJ ! L <br />/1 1�• r 7 irf c C� /.•K <br />I /_ / A V 2 i �... -,..V IL �` . 1 �r / /7 //1 i t ✓ ✓ O pih <br />2 L 4F /Gt /,' ,4 /7 <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 />( Y Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Pogo 10 of 20 <br />S <br />zo. -t1 <br />Sample Loc. /ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .2 S25338 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />0/4 sTiz <br />Sample Date S - 19 - 20 // Time ? • I /0 Date Data Entered <br />re <br />Collected By 11 D S .✓,✓ c ..I. 74 Data Entry By <br />Field Custodian /So I_, r V..V .. r Laboratory Destination if not Cotter: <br />Cotter Off - S to Destination -A. r' . s_ / c �� .� f <br />c. / 0- / ,s. 1,, c <br />Delivered By 2 ? S ? • s c; / f t'�� ." 4' 4,w//. <br />Received By r r- , `..- /,0/j" ',-, 1 ( O Z. <br />Date Recd. <br />Time Recd. ■ <br />/ t, <br />1. Sample Type: Air Water ff Soil Other (specify): <br />2. Analysis - Test series requested: 7-4 4 / / 4/ 2 <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />3. Field Data - Preservation: r; <br />-a ..: <br />�5 <br />i nv t e c" � t is� / . / 1 7 " c.� / 3 , d YJ ! L <br />/1 1�• r 7 irf c C� /.•K <br />I /_ / A V 2 i �... -,..V IL �` . 1 �r / /7 //1 i t ✓ ✓ O pih <br />2 L 4F /Gt /,' ,4 /7 <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 />( Y Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Pogo 10 of 20 <br />