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40W v%i <br />COTTER CORPORATION SAMPLE STrAND TRACKING FORM <br />Sample SOOWttal <br />..0. lox 1750 S: P.O. Box 1750 <br />N: P.O. Box 700. <br />0410 City, CO 81215 Callon City, CO 81215 Nucla, CO &JAU <br />mob% ftr- <br />Lab. No.(s) <br />71 Thue 0 Date Data Entered <br />Tco - <br />Data Entry By <br />Laboratory Destination If not Cotter: <br />Cotter off-Site 9"dusti <br />on V'i f CA t <br />Tr i-lie it C—eci <br />—7777 <br />Ank <br />JW) <br />Cl <br />Air Water Sell Other (specify): <br />yW& TW series requested: <br />4-7 Co. le -371 R 21c�' <br />4-3-1,0 (210, A, 4 41ox <br />01 <br />required by (if not Hobling Time): <br />conditions or otbW Ivistructions: <br />circumstances? H YES Initial and explain below. <br />Upkmatiou of noted Items: <br />) Check H additional attachmeoft. <br />QA SWF*w: <br />YES NO If NO, explain: <br />QAC Date <br />Page 8 of 8 <br />