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{ <br />1 <br />C: <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACII;ING FORM <br />Sample Submittal <br />P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 706 <br />Cation City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. At W ` X Lab. No.(s) <br />Sample Date Time <br />Collected By % y Ze-.r d <br />Field Custodian 1-�4 7r-w .s <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a.vaaaa <br />vaa -uaac a�rwuuuvu <br />d L A, <br />k <br />1. Sample Type: Air <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />43 7.3 S'<-' l e (-,e e e .y <br />t <br />�� r <br />Water Soil Other (specify): <br />2. Analysis - Test series requested: _ % /- /,r- 0",. <br />3. Field Data - Preservatiofn:e� j �f �. '� . +� {7 j? r i t <br />/' 1 n C C f •1 � /9 , /.Jr a ..� .1. A "i � » �. � / �-'. � �j{ ~ j � %J i t / ' / <br />T <br />4. Date analysis required by (if not Holding Time): <br />S. 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 ( <br />QAC <br />) NO ( ) If NO, explain: <br />Date <br />Page 20 of 20 <br />