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C: P.O. Box 1750 S: <br />Cation City, CO 81215 <br />Sample Loc./ID No. <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal El! S 2$11110 <br />S 1.4) Aoal <br />Sample Date 7-2 7- If Time 0 <br />Collected By 04 <br />Field Custodian. ,4 a <br />Cotter Off-Site Destination <br />Delivered By AO 49484 17 64,41 f It> 3 9 3 S e // Lip, <br />'Fe/Ey qi: s1' s oA i I/ f <br />10 <br />‘ ja Pie be <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: re ale <br />3. Field Data - Preservation: f ./ %'. <br />c. q, <br />3 g <br />6. Invalidating circumstances? If YES initial ( <br />COMMENTS - Explanation of noted Items: II v <br />QAC <br />'CT; <br />P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Date Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />8 ::) .40 el" 41. Craw 411 1 r <br />j .5 1 #A413 <br />4. Date analysis required by (if not Holding Time): <br />5. Special bandling conditions or other instructions: <br />• ) and explain. below. <br />e t . /1410# of etive r <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />Page 33-of 39 <br />