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Sample Loc./ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />4 P.O. Box 1750 <br />: <br />Cason City, CO 81215 <br />Sample Date - Time ►./ 0 <br />Collected By :. <br />Field Custodian /jEJ 4, 77°11 A4 N <br />_ Cotter <br />Off-Site Destination <br />Delivered By /Sot rioh G -1 f feJ4 <br />Received By f /ill <br />Date Recd. <br />Time Recd. /0 <br />Sample A <br />I. Sam <br />p Type: Air <br />2. Astaitils— _ Test series requested: ( <br />Sample Submittal <br />6. &Validating circu nces? If YES initial ( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S: P.O. Box 1750 <br />Canon City, CO 81215 <br />0 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination not Co m*: <br />e z ' 3 S4 6. k s/e.e. <br />Y P'24 0 / <br />t A v <br />Soil _ Other (specify): <br />_sue <br />N: P.O. Box 700 <br />Nucla, CO 81424 o e s e <br />3. Field Data - Preservation: ray 2 0 .0 fi 2 93 ,4 el 17257 4 �/ 1 <br />i A St/ to /3.3 _ s4.4 ( tom �� � 0....•.� <br />Z L (Z.4J//1/U l <br />ate analysis by (if not Holding Time): _ ., <br />5. Special handling conditions pr1; rijirtructions: , <br />) and explain below. <br />COMMENTS - Explanation of noted items: <br />go wits g <br />If NO, explain: <br />Page 9 of 9 <br />