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K ( <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11.1 .S 26473 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Callon City, CO 81215 Callon City, CO 81215 <br />Sample Loc./ID No. <br />St' 4 c" <br />sample Date S 9- 20a. T ne 2.-yd <br />Collected By ig o 1 w• c 7'`' <br />Field Custodian 4 0,4 1a •A <br />Cotter Off -Site Destination <br />Dellvered By J 4 1; .1 Lt P o <br />Received By re, 14 X Fek r 44- <br />D R S' "/0- E01) W <br />Time Recd. y. 4ot- W • <br />,, o ✓ <br />1. Sample Type: Air Water / Soil <br />2. Analysis - Test series requested: CQ 1e 1 <br />3. Field Data - Preservation: r � _ 5 d # '1.3 0 e �- �'• Z V � G "�) ^ <br />fr / �' l'o ., c Z.3sc. -�S ,./-� : Q ` C�. S " L1�t'W #4'o 24 '3 :...J • <br />Std 4* <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 />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 />y._ <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination i not Cotter: <br />-27 3 S a C°r P � . <br />Co f/ 31' te/ y. e z. 6 a 1 <br />Other (specify): <br />) and explain below. <br />N: P.O. Box 709 <br />Nucla, CO 81424 <br />Page 7 of 8 <br />