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a.0 «or a <br />a es nti <br />a on <br />��J ( ' <br />' // l <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :: s2“43 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. (Ai L PL. Lab. No.(s) <br />Sample Date 9 " 1 7 /° Time 0 v Date Data Entered <br />Collected By /_. n 4'n.7 A C 1 Data Entry By <br />Field Custodian A 04 7; 4 n i - , Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Off <br />Time Recd. <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: (1 Fs/42_ / <br />3. Field Data — Preserva on: 7 ' 4 4 3 if J ,if 7. '75 r .' .t, < . 2, (i C, K d s is , ' <br />i / /1 f C (' ),� (h z ,&..4. i. ¶ 4,1 -t t" `" cites a5- o -hey /5( <br />0, 5- G AA // 0, 2 , �,_..... <br />Z3 7 vs- <br />_c_s4 /t (r., k ,„ <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 />QAC Date <br />Page 6 of 6 <br />