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Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C:. P.O.Box1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. .5 P4- <br />Sample Date 9-be - /AZ Time /h 4 6) <br />Collected By 6 a 11 el a .a <br />Fwd Custodian /. ee 7. A 4.'t t <br />1. Sample Type: Air Wat Soil Other (specify): <br />2. Analysis - Test series requested: Co 10 <br />3. Field Data - Preservation: ¢' 9.? <br />A <br />I. <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 />Saispie valid? YES ( ) NO ( <br />QAC <br />Sample Submittal <br />tt S21443 <br />5: P.O. Box 1750 <br />N: P.O.Box700 <br />Canon City, CO 81215 Nucla, CO 81434 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />LA f f C [.,. C 6 i. f v/ r *F 'i rA. <br />23 ► 3 / '.rte 4 Aliwit <br />c ,, } (V. g z cal <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 8 of 10 <br />Wt..MMICE <br />lli! ■olac LO�ilufluu <br />//�f <br />■ <br />// <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C:. P.O.Box1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. .5 P4- <br />Sample Date 9-be - /AZ Time /h 4 6) <br />Collected By 6 a 11 el a .a <br />Fwd Custodian /. ee 7. A 4.'t t <br />1. Sample Type: Air Wat Soil Other (specify): <br />2. Analysis - Test series requested: Co 10 <br />3. Field Data - Preservation: ¢' 9.? <br />A <br />I. <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 />Saispie valid? YES ( ) NO ( <br />QAC <br />Sample Submittal <br />tt S21443 <br />5: P.O. Box 1750 <br />N: P.O.Box700 <br />Canon City, CO 81215 Nucla, CO 81434 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />LA f f C [.,. C 6 i. f v/ r *F 'i rA. <br />23 ► 3 / '.rte 4 Aliwit <br />c ,, } (V. g z cal <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 8 of 10 <br />