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Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i- S21452 <br />C: P.O. Box 1750 <br />Cafon City, CO 81215 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Caution City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S -A .0O / Lab. No.(s) <br />Sample Date q ' S " ! 2. Time O": Date Data Entered <br />Collected By )3 o 4. Tp et A es j Data Entry By <br />Field Custodian )1)' T .. t Laboratory Destination if not Cotter: <br />Cotter Off Site 1>estiaattaoa r P✓ir y 14. im 4 t:, r s c . <br />Delivered By 'Z 3 i J Salt ( r e t f/ t y, <br />• <br />Lay 2cC. ie <br />co- 64 <br />1. Sample Type: Air Water 1 / Soil Other (specify): <br />2. Analysis - Test series requested: d 4. <br />3. Field Data - Preservation: T 2 . 7 t 4 . t ' rte, 100 1 , t L .41%". <br />AP Q rd,.,1 r,),,1,1• JY,"` 0, s L P4 01 /A/ z . <br />_A - r s F � w <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 - Explanatlon of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 36 of 42 . - <br />NJ f <br />y r <br />Q <br />-G <br />- c - <br />1' . 9 5 <br />r S b %ssr <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i- S21452 <br />C: P.O. Box 1750 <br />Cafon City, CO 81215 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Caution City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S -A .0O / Lab. No.(s) <br />Sample Date q ' S " ! 2. Time O": Date Data Entered <br />Collected By )3 o 4. Tp et A es j Data Entry By <br />Field Custodian )1)' T .. t Laboratory Destination if not Cotter: <br />Cotter Off Site 1>estiaattaoa r P✓ir y 14. im 4 t:, r s c . <br />Delivered By 'Z 3 i J Salt ( r e t f/ t y, <br />• <br />Lay 2cC. ie <br />co- 64 <br />1. Sample Type: Air Water 1 / Soil Other (specify): <br />2. Analysis - Test series requested: d 4. <br />3. Field Data - Preservation: T 2 . 7 t 4 . t ' rte, 100 1 , t L .41%". <br />AP Q rd,.,1 r,),,1,1• JY,"` 0, s L P4 01 /A/ z . <br />_A - r s F � w <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 - Explanatlon of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 36 of 42 . - <br />