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Sample Loc./ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ' at S MI6 . <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nacla, CO 81424 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Date 7- 27 -2 1I/ Time pi 90 <br />Collected By Z04 Troy/104 <br />Field Custodian "Jot r,P.r.,v! •vr <br />Cotter Off-Site Destination <br />Delivered By Ad. ��P,srw<<.� �yP ye_ <br />Received By <br />• Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />e ..4.4.0 . fry Lc thse4 hoe es <br />• ecd. <br />1. Sample Type: Mr Water / _ <br />. Soil Other (specify): <br />2. Analysis -- Test series requested: ee, (JP a' I <br />3. Field Data Preservation: r '4. z o# t� Coo we,' 2 2 .S dealt r. lt 1 <br />v,s t -' 7.3 & S `=r `; cis 4 f %r' <br />f�Q -. .2 <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or - other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS. - Explanation of noted items: ilk l ft 1/ ✓• '6 1+ <br />QAC Date <br />( ) Check. if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Page 39 of 39 '-- -' - <br />