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L <br />vu -ona 1/C611111111111/11 <br />JJ a.uLI <br />/SO <br />• - - <br />: .z <br />.-s 6 : ss c <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O.,ilex 177S* S: <br />Call'`. ls8215 <br />Sample LocJID No. ' 05 <br />Sample Date 4 S " 1 a� Time / • Z <br />Collected By gt14 7 ri u .#11 <br />Field Custodian go 4 7 q n 1 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Reed. <br />1. <br />Sample Type: Air <br />2. Analysis - Test series requested: e' N e / <br />3. Field Data - Preservation: 1 • s <br />r /if" c'o— 1,!b ° <br />-CAW - . 78 <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 ( <br />COMMENTS - Explanation of noted items: <br />{ ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />sUi456 <br />P.O. Box 1750 N: P.O. Box 700 <br />Calton City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory ✓ s s Destination if not Cotter: T <br />iv be G 6 osG7 ' i3 L- <br />/ 11' tie <br />2. 353 Sc. / Cyreehe NuJ <br />ee('va , L /y. 916 <br />EIV <br />Water i Soil Other (specify): <br />// 7.22- (a,J 2.00 s <br />v. 3 Z / <br />) and explain below. <br />Date <br />- =`= Page 40 -of 42 <br />