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leV «Cl <br />Vli•OlK JJC5UU UUU <br />4 r . <br />rl4 A A <br />f` - - <br />l <br />o <br />g_ <br />. 6- 9 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal Li! S26457 <br />C: P.Q 113. 171 S: P.O. Box 1750 N: P.O. Box 700 <br />Cams City, i~O 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID "1 .. 5 1 ) 'el- .5 Lab. No.(s) <br />Sample Date 4 IF " S ' /#& Time C • 30 Date Data Entered <br />Collected By )317 ( i9..+.01 Data Entry By <br />Field Custodian Labotatory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water I Soil Other (specify): <br />2. Analysis — Test series requested: C �i pfd t <br />3. Field Data — Preservation: 7— a l /1 7.3 Sr ('n . e.) ZS'? / « i <br />rr r -e.k i 1.67 f.„54.J-t. s _ ``s /JAW 2 . J <br />1. 2 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 />Sample valid? YES (" ) NO ( ) If NO, explain: <br />0 <br />� PrC (1 Z4 40.e. tar <br />' °s I c <br />011 Yy `l Vii:. 2 r <br />QAC Date <br />Page 41 of 42 <br />