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C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Loc. /ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .. s25858 <br />Sample Date 1 6 - 0 1 . 15 f/ Time /3 O 5 Date Data Entered <br />1 <br />Collected By / p vrve r... Data Entry By <br />Field Custodian 4 0 6 �'.✓ ".14 4 . t Laboratory Destination if not Cotter: <br />Cotter Off Site Destination <br />. r L < L s Teb'/ S <br />g /az s <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />r� <br />x" <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: e 1.4. / <br />3. Field Data - Preservatio : T .4- 1 /4' 7 75^ f . 1 2 ?‘ to 1 - e. '~ <br />a. r <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: f tit 5; Z e 12 ,f <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />['ago 11 of '13 <br />o <br />7o�•✓Nc1 <br />/t. _ <br />rr <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Sample Loc. /ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .. s25858 <br />Sample Date 1 6 - 0 1 . 15 f/ Time /3 O 5 Date Data Entered <br />1 <br />Collected By / p vrve r... Data Entry By <br />Field Custodian 4 0 6 �'.✓ ".14 4 . t Laboratory Destination if not Cotter: <br />Cotter Off Site Destination <br />. r L < L s Teb'/ S <br />g /az s <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />r� <br />x" <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: e 1.4. / <br />3. Field Data - Preservatio : T .4- 1 /4' 7 75^ f . 1 2 ?‘ to 1 - e. '~ <br />a. r <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: f tit 5; Z e 12 ,f <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />['ago 11 of '13 <br />