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w <br />. COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal IAA S 2 6 313 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 812159 gyp/ Calton City, CO 81215 <br />Sample LocJID No. $4. / i— <br />Sample Date 5 - / Time <br />Collected By AS v !s -�~ r'� M n t <br />Field Custodian / o 6 / '4e" - ' <br />Cotter j, Off-Site Destiiatloa <br />Delivered By • 45 P a if , ' <br />Received By C. f . -N04 <br />Date Recd. ' 9.- - <br />Time Recd. <br />1. Sample Type: Air <br />3. Field D Preservation: re <br />Lab. No.(s) <br />2. Analysis - Test series requested: re. A J <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotten: <br />✓ Lci�D� a,.l��+r ° 14c <br />! s �e - .L/y g z ‘'d/ y' <br />Water 7 Soil Other (specify): <br />N: P.O. Box 780 <br />Nude, CO 81424 <br />e Data - rva on: �7 d s • <br />• -t J <br />s err= /-s r/v 4, f / 11 /1 /r -r N,5o <br />S '.• -�. / a. S L 41f4111 0# <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional .attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 29 of 29 <br />