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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . S 2 5 8 6 Q <br />C: P.O. Box 1750 <br />Callon City, CO 81215 <br />$ <br />Sample Loc. /ID No. 4 A / - <br />,1 <br />Sample Date "~ i -2a // Time / 0 <br />Collected By 1� o s 1 l�,.,,u •.� 1 <br />Field Custodian 4„ 1 I �... 7� Laboratory Destination if not Cotter: <br />Cotter 0[[ Site Destinat ' A. 0J 14 6 v. l - . •? k ti c <br />? 3 Z ;i S c$1,/ y�� Wi.., ,,�. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a. <br />Sample Type: Air Water �7 <br />2. Analysis - Test series requested: <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />v r' <br />Soil �-^ Other (specify): <br />,ors��o <br />3. Field Data - Preservation: 7_ / 6./ ,,(a /i ZS? ! n �+..-l. I g / !, s <br />I A/ s t o �'n.�� , 3 0 .t 5 d ti ° < 7/ c.11 - 90 e <br />& J /z. 1.2 5_ /i f ./f'4" 2 s f / <br />/ Leifer /4 5 : -� 5 , ., f s 0. S " L. /./A 4/c u// 7 ,. <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: - : / I / ' > j/ 1 f 7 <br />t / / P.f A ? e �P✓ (� /.•,Q / , � c /.e 1`/7 el <br />Pogo 43 of 43 <br />QAC . Date <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />• <br />— <br />■ <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . S 2 5 8 6 Q <br />C: P.O. Box 1750 <br />Callon City, CO 81215 <br />$ <br />Sample Loc. /ID No. 4 A / - <br />,1 <br />Sample Date "~ i -2a // Time / 0 <br />Collected By 1� o s 1 l�,.,,u •.� 1 <br />Field Custodian 4„ 1 I �... 7� Laboratory Destination if not Cotter: <br />Cotter 0[[ Site Destinat ' A. 0J 14 6 v. l - . •? k ti c <br />? 3 Z ;i S c$1,/ y�� Wi.., ,,�. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a. <br />Sample Type: Air Water �7 <br />2. Analysis - Test series requested: <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />v r' <br />Soil �-^ Other (specify): <br />,ors��o <br />3. Field Data - Preservation: 7_ / 6./ ,,(a /i ZS? ! n �+..-l. I g / !, s <br />I A/ s t o �'n.�� , 3 0 .t 5 d ti ° < 7/ c.11 - 90 e <br />& J /z. 1.2 5_ /i f ./f'4" 2 s f / <br />/ Leifer /4 5 : -� 5 , ., f s 0. S " L. /./A 4/c u// 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: - : / I / ' > j/ 1 f 7 <br />t / / P.f A ? e �P✓ (� /.•,Q / , � c /.e 1`/7 el <br />Pogo 43 of 43 <br />QAC . Date <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />