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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />saw i � <br />SIAM <br />A tins <br />N: P.O. Box <br />Nucla, CO - <br />C: P.O. Box 1750 n) S: P.O. Box 1750 <br />Ceiei City, CO 81215 V Cafio* City, CO 81215 <br />Sassifle Loc./ID No. S! 47,71 Lab. No.(s) <br />litialipie DSte 2. 'i1 '/7 Time Vt' <br />c .By <br />fluid Cutodlan ./ . :t:,,^ <br />Cotter Off -Site Destination <br />1100; igked illy I <br />T . <br />C <br />1. <br />Smote Type: Air Water 7 Soil Other (specify): <br />2. ASOiiyals — Test series requested: 1 ; 4f , <br />3. MO Data — Preservati9,n: T c (7.7 a',0 ? 5 ~ l; dt / 2 7L r $ , ''.. <br />"� •� s ry „ _ Z . 7 C) . / 6 A /7 , , 0 t� <br />/. 7 F ("v 4 // 7 .,� . , �� " {,'• ,4 4 . oo- <br />s , 1 (I/f , 0. 5 4-- r.'''r7-1 N cit'y 7 . S ,..... <br />- Dale analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Iuvltlidetig circumstances? If YES initial ( ) and explain below. <br />CON 1611111S Th — Explanation of noted items: <br />( ) Check if additional attachments. <br />QASisw: 'l <br />Sample valid? YES ( ) NO ( ) ; If NO, explain: <br />QAC Date <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Page 25 of'26 <br />1 <br />