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Delivered By <br />Received By <br />Date Recd. <br />Tinie Recd: <br />5. . <br />COTTER CORPORATION SAMPLE-SUBMITTAL AND TRACKING FORM <br />Sample Submittal M. S 214 5 4 <br />C: P.O. Box 1750 <br />Cason City, CO 81215 <br />Sample LocJID No. W .f L <br />Sample Date - S - P . Time : 2 S <br />.Collected By ad () 7: f <br />Field Custodian £v 4, ToAnCA <br />•%' ice' <br />Water ' Soil Other (specify): <br />2. Analysis - Test series requested: (JQ <br />1. Sample Type: Air <br />3. Field Data - Preservation: r a" 2. 3 <br />S: <br />4. Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( <br />COMMENTS - Explanation of noted items: <br />( ), Check if additional attachments. <br />QA Revilew: <br />Sample valid? YES ( ) NO ( <br />QAC Date <br />P.O.Bei1750 N: P.O. Box 788 <br />Cason City, CO 81215 Nucia, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Labogatory Destination if not Cotter: <br />Eif8/ y £l o #4. # ! <br />f Silt C. p e It //� . <br />( ee &1%. F ? ( f a t <br />� <br />) and explain below. <br />2 .�. <br />• • <br />) If NO, explain: <br />Page 38 of 42 <br />v1I III an UU• <br />- �L•UtICr <br />l ? e i / - P 0 1 6 4 t <br />ft ° C/b <br />ipoily <br />r0-4 <br />y -G -) 2 <br />/6 <br />A S G : cs e i <br />Delivered By <br />Received By <br />Date Recd. <br />Tinie Recd: <br />5. . <br />COTTER CORPORATION SAMPLE-SUBMITTAL AND TRACKING FORM <br />Sample Submittal M. S 214 5 4 <br />C: P.O. Box 1750 <br />Cason City, CO 81215 <br />Sample LocJID No. W .f L <br />Sample Date - S - P . Time : 2 S <br />.Collected By ad () 7: f <br />Field Custodian £v 4, ToAnCA <br />•%' ice' <br />Water ' Soil Other (specify): <br />2. Analysis - Test series requested: (JQ <br />1. Sample Type: Air <br />3. Field Data - Preservation: r a" 2. 3 <br />S: <br />4. Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( <br />COMMENTS - Explanation of noted items: <br />( ), Check if additional attachments. <br />QA Revilew: <br />Sample valid? YES ( ) NO ( <br />QAC Date <br />P.O.Bei1750 N: P.O. Box 788 <br />Cason City, CO 81215 Nucia, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Labogatory Destination if not Cotter: <br />Eif8/ y £l o #4. # ! <br />f Silt C. p e It //� . <br />( ee &1%. F ? ( f a t <br />� <br />) and explain below. <br />2 .�. <br />• • <br />) If NO, explain: <br />Page 38 of 42 <br />