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• %Amor <br />ana -past: i.'v u uoll <br />. <br />_G <br />67s 5 . <br />.r; G =.asr <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 <br />Callon City, CO 81215 - <br />Sample Loc./ID No. S 1) g DI <br />Sample Date Loi ' ' a) Time g : 0 <br />Collected By At) I T PA n G .n <br />Field Custodian f 4, /IA * r♦ t <br />3. Field Data - Preservation: 7 v~ <br />r r n _ Z , //x 5 7 I./ <br />S: P.O.Box1750 <br />f �.t <br />1. Sample Type: Air Water , / Soil <br />2. Analysis - Test series requested: a t <br />4. Date . analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( • <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO" ( <br />QAC <br />S2HHS3 <br />N: P.O. Box 700 <br />Callon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Eit Lc.4t:rG foe IoS c_ - <br />z3`3 Salt(.,rQ4 iii4 <br />C4 sr e, 4/9. S2 6 cJ <br />• <br />w I i <br />Other (specify): <br />2.9 / / 07./g ( 7 , 4 / <br />S � O. ) T Lf4f{ #o a.7 <br />3 <br />. ) and et$0,10•be10w, <br />COMMENTS - Explanation of noted items: <br />) If NO, explain: <br />Page 37 of 42 <br />