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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />SUL u7 <br />C: P.O. Box 1750 <br />Callon City, CO 81215 <br />Sample Loc./ID No. 6) A Li f <br />Sample Date ri ' 2 d — f 2 Time /6../ 0 <br />Collected By got 7'0'i Men <br />Field Custodian `� ' 1 n a <br />Cotter Off -Site Destination <br />Delivered By eo� 4A 17 P cI : <br />Received By <br />Date Recd. <br />Time Recd. <br />f ('eitA • kv <br />Idzzi <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: ( <br />ro‘ /3 ////(6.5 (1- 3 2 <br />r I /71 P 4 /2 4e i s ` , 0, 5 C ' /f # * ' 2 <br />C ' 4 <br />3. Field Data - Presery tion: <br />Sample Submittal <br />( <br />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 ( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />L <br />' P ✓ 5. y L. S 4..,„ <br />-z .3 9.7 .S (' e <br />) and explain below. <br />Date <br />( s p, I/ S' 7 ( <br />Soil Other (specify): <br />COMMENTS - Explanation of noted items: <br />) If NO, explain: <br />Page 7 of 8 <br />