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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 5U‘45 <br />C: P.O.' Sox .1750 S: P.O. Box 1750 N: P.O. Box 700 <br />COMM City, CO 81215 Cation City, CO 81215 Nash, .CO 81424 <br />Sample firoc.fi0 No. S (J 0 C Lab. No.(s) <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />3. Field Data — Preservation: °` ;z-13 <br />r iA <br />•tt44 1$ C <br />{ ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />Sample Date / ` 5 — _ ' 2 - Time � 3 ' Date Data Entered <br />Collected By go 6 T,o, -7 Data Entry By <br />Field Custodian IS p,4 I n /1 4 Laboratory Destination if not Cotter: <br />t1 Qv S y Le. aic <br />1343 5dt (re test lr Rzy. <br />may. 8zCv <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested:) fl /P / <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 />) If NO, explain: <br />QAC Date <br />Page 39 of 42 <br /><.IPILCl <br />U11.7IWC 1/CNLIU <br />IIUU <br />�' 0 1 <br />e f <br />ACC <br />! 79d <br />7' <br />-la <br />/0.: <br />9.5 <br />- r <br />: _ S � <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 5U‘45 <br />C: P.O.' Sox .1750 S: P.O. Box 1750 N: P.O. Box 700 <br />COMM City, CO 81215 Cation City, CO 81215 Nash, .CO 81424 <br />Sample firoc.fi0 No. S (J 0 C Lab. No.(s) <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />3. Field Data — Preservation: °` ;z-13 <br />r iA <br />•tt44 1$ C <br />{ ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />Sample Date / ` 5 — _ ' 2 - Time � 3 ' Date Data Entered <br />Collected By go 6 T,o, -7 Data Entry By <br />Field Custodian IS p,4 I n /1 4 Laboratory Destination if not Cotter: <br />t1 Qv S y Le. aic <br />1343 5dt (re test lr Rzy. <br />may. 8zCv <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested:) fl /P / <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 />) If NO, explain: <br />QAC Date <br />Page 39 of 42 <br />