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l.,..AC. <br />Old Slte 1)est,aatiVA <br />P . 1 <br />4. <br />If 1 <br />X - C <br />-6• /-1- <br />I0,. � S <br />r �: G:35e <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 <br />Sample Loc./ID Nosh/ — 4 4) 1) <br />Sample Date ' � ' �� Time 0 <br />Collected By &a 4 / 0411A 41. <br />Field Custodian j t1 re Ail4 it t — <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />• <br />P.O. Box 1150 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />N° $26451 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />4 fr G Z-4 6 vrc far, - <br />2. - 493 Sc. if Ea ✓ee #<...r�. <br />(".a.sce 4 7(0/ <br />so <br />_ �k <br />1. Sample Type: Air Water { f Soil Other (specify): <br />! <br />2. Analysis - Test series requested: 4 /e <br />Q'- <br />3. Field Data - Preservation; T Z. 0 1 .4i/ , ( , . 2 t 1 <br />rem e C..6 '. Z• f� -� r ' ,rA) ) Cff1,JW0 2 0 <br />I L,r /,2 s 6- /M4? 2s' /6- t ; 1L 4'FA /t So <br />=,..�. D. i - 4 ir 1 4OO1 2.5 <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 />COMM NTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />4• • <br />.Page 35 of:4 ",, <br />