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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S26$4S <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 1/ <br />Sample Loc./ID No. 5 C42 4 A 1 <br />Sample Date /(l 10 Time /I 15 <br />Collected B y ) S a nn t , t , 1 4 "7 - r <br />Field Custodian IT? .' /.3 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />3. Field Data - Preservation: <br />QAC <br />�? � rte <br />1. Sample Type: Air Watery 2 Soil <br />2. Analysis - Test series requested: S .1 <br />rtry t �' 1- Z., - .-, -t <br />6. Invalidating circumstances? If YES initial ( <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 <br />BCD <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not <br />2-3 _r / S '�i <br />Nucla, CO 81424 <br />Cotter: <br />f . $ Z� , <br />rt� f' h // <br />Other (specify): <br />�. r' (2 <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) 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 />Date <br />Page 8 of 9 <br />%All&MI <br />WI1.0IIt 1,V <br />MUUMUU <br />/. <br />' , <br />770 4 A .', Al' <br />i" <br />- t er. <br />Syr <br />to <br />2 11 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S26$4S <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 1/ <br />Sample Loc./ID No. 5 C42 4 A 1 <br />Sample Date /(l 10 Time /I 15 <br />Collected B y ) S a nn t , t , 1 4 "7 - r <br />Field Custodian IT? .' /.3 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />3. Field Data - Preservation: <br />QAC <br />�? � rte <br />1. Sample Type: Air Watery 2 Soil <br />2. Analysis - Test series requested: S .1 <br />rtry t �' 1- Z., - .-, -t <br />6. Invalidating circumstances? If YES initial ( <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 <br />BCD <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not <br />2-3 _r / S '�i <br />Nucla, CO 81424 <br />Cotter: <br />f . $ Z� , <br />rt� f' h // <br />Other (specify): <br />�. r' (2 <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) 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 />Date <br />Page 8 of 9 <br />