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4. <br />5 . <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal , 112 S 2511,2 <br />C; Rol; 1750 : S: P.O, Boa 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample LocjIli No. • eh Lab. No.(s) <br />siunpiemite 7-27 2 I - Va <br />Collected By ige t) <br />Field Custodian . reedy/vat Aft <br />. <br />Cotter °Mite Destination <br />Delivered By /39L . <br />Received By C <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water Soil <br />—t ( <br />th (1 <br />2. Analysis Test scrim requested: ( <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered. <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />y 44 4 oe4 te S , <br />3 56.4 e e ek frAtlyq <br />eels 1?3,401 <br />Other (specify): <br />3. Field Data - Preservgdon: / WL . J o, # Rs" 4.) 7 ei S - 4° <br />chvse ep,„, 3. (4, ‘41 10, f // ir R. <br />— s <br />A - <br />Date analysis required by (if not Holdingilme): <br />Special handling conditions or other instructions: <br />6. Invalidatinreircumetances? If YES initial ( ) and explain below. <br />COMMENTS - Etplanation of noted items: g vie, <br />( ) Check if addltimal attaclunents. <br />QA Review: <br />Sample valid? YES( <br />) NO ( <br />QAC <br />) If NO, explain: <br />Date • <br />• <br />_ _ _ _ Page 35_of_39 <br />