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a.u«Ca <br />vu ■ouC LCi1W4i1V4 <br />• . Mill <br />f -C <br />_ ) 2 <br />/e! PS' <br />A •'S G.ssC <br />COTTER CORPORATION SAMPLE AND TRACKING FORM <br />Sample Submittal i!o S 26 # 5 4 <br />C: P.O. Box 1750 <br />Cafion City, n CO 81215 <br />Sample Loc./ID No. .S W fG► <br />Sample Date - " / Time g . 2 S <br />Collected By /30 + 7'et11 e 4, t <br />Field Custodian £d 4) 7 t <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />6 ,,, d,f <br />1. Sample Type: Air Water r Soil <br />2. Analysis - Test series requested: (T 042 1 <br />3. Field Data - Preservation: ...rod-- 2 3 • ye' fi <br />y / � .Q eon' 7. i2 <br />$ 9 - ) <br />Sid - 1, s' <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 />Sannple valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />S: P.O. Box 1750 <br />Cation City, CO 81215 <br />f <br />N: P.O. Box 784 <br />Nucia, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />E/#e'� 7 I r <br />G 'e o # c. tat s .C,.. t .. <br />31 S C - Q(.lc <br />f � <br />Other (specify): <br />4, � � ZOO 4.,5, -, • <br />O. LPG /1,i/c, 2. <br />Page 38 of 42 <br />