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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 2 SIMMMS <br />C: P.O. Box 1750 S: <br />Cafion City, CO 81215 <br />Sample Loc./ID No. J kJ ,4 1f# <br />Sample Date 12-12 12 Tune `0 • /0 <br />Collected By av S vo„ .� a <br />Field Custodian 6 T, A n G A <br />Cotter Off -Site Destination <br />r �. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />2. <br />3. Field Data — Preservation: T <br />°` /• 7 <br />if .0- o Z,2 ? ,-J-t <br />L C/ f,4 /9A/0 /0 .w-J <br />7 <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 />Cafion 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 c 4 v -74, v -` S" 7_ �. <br />2 92 d Sc, (77 h <br />Kc , po t /d7. ■ <br />Water .-5 Soil Other (specify): <br />Analysis — Test series requested: ( r e/o <br />7. ?S <br />o , /r • ,CA <br />//No , U .....�_ . <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 />) If NO, explain: <br />Date <br />Page 9 of 9 <br />