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Delivered By <br />Received By <br />Date Recd. <br />Time. Recd. <br />1. <br />QA Revie'i <br />Sample valid? <br />COTTER CORPORATION SAMPLE SUIBMITTAL ANDI TRACKING FORM <br />Sample Submittal ( s2S <br />P O. Box 1750 <br />Cation City, CO 81215 <br />Sample Loc./ID No. eto *5 . 4b.No.(8) <br />S: P.O. Box <br />Sautple Date ' 2 f - 2 W Time ?r 5 " <br />Collected By g4 �.. --.✓, .�.'- <br />• • Field Custodian 0.440 ' <br />Cotter Off -Site Destination <br />1750 <br />Callon City, CO 81215 <br />D to Data Enterel <br />Data Entry By <br />Destination if not Cotter: <br />2311 e o, @ <br />Sample Type: Air Water t Soil Other (specify): <br />Analysis I`est series requested: ' <br />Fleld Data — Preservation: r at- tel 7. :. eso w R . 3 -c I <br />sAd 4 rft 0.1 c .i j ` 3.3 * salft 4 - Pi L./ 1 7 `' <br />, :i / C P //Aid" 2 . U. / l ij � AN <br />N: . P.O. Box 700 <br />Nucla, .CO 81424 <br />ysis required by (if not Holding Time): <br />handling conditions or other instructions: <br />6. Invaliding circumstances? . If YES initial ( <br />) and a *plain below. <br />COMMENTS - Explanation of noted items: <br />eck if additional attachments. <br />YES ( ) NO ( ) If NQ, explain: <br />QAC <br />x CJ • <br />i ce <br />k. <br />Pag6u24 :• _ <br />:5 <br />