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. COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal � 1 <br />C: P.O. Box 1750 S: P.O. Boat 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Cation City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. L-,./- /T Vj L <br />Lab. No.(s) <br />Sample Date - Time 1 ; Y 1" <br />Collected By U ,L- <br />Field Custodian �'L S P+t (A # <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />a.%V VIA <br />Vl�N1LC UCSilaaA00 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />IX <br />riot yjr r <br />2--3 9 ; I - ( w`/ <br />CC41 LZ <br />c <br />L 1 Aqj. , n Qfi <br />Sample Type: Air Water t Soil <br />Analyst$ " Test series requested:_, , 4 <br />3. Field Data - Preserves: <br />" W <br />( v� /. -90 <br />4. <br />5. <br />Other (specify): <br />'�i_ P7 -f 7.0$ CAA 4 1 %- <br />Date analysis required by (if not Holding Time)i <br />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 25 of 25 <br />