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AMC/ <br />WI A 011,G iLMEMIllilLIULI <br />- Ill (A....) <br />Elk i <br />, <br />COTTER CORPORA <br />(.0 <br />SAMPLE SUBMITTAL AND TRACKING FORM <br />spiplipttai S 25816 <br />tei 6 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 k..) <br />Sample Loc./ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />P.O. Box 1750 <br />Cafion City, CO 81215 <br />• #7 Lab. No.(s) <br />Sample Date -7- / e I() Time /..3 <br />Collected By I A. <br />Field Custodian ': - Al I <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />• <br />•11.1•MII0 <br />N: P.O. Bk700 <br />Nucla, CO 81424 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: (71 <br />3. Field Data - Preservation: 1 7 5 <br />f <br />41 r 4 v-d te . / 1' ,4 N <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 />II" 41/, <br />CONMENTS - Explanation of noted items: („< f • / 5 • r z <br />r, f 4. 4 , 1 /7 <br />) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />-4 Page 27 of-28 • <br />