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1 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal % &27091 <br />C: P.O. Box 1750 S: P. <br />Canon City, CO 81215 C <br />Sample Loc. /ID No. -:. ,'" + V-0 O. Box 1750 N: P.O. Box 700 <br />Ca <br />Sample Date — ��-13 lime y • D 4 <br />Collected By � <br />1) <br />Field Custodian <br />1 2 <br />Cotter Off -Site Destination <br />Delivered By 3. <br />� <br />Pd <br />Received By <br />d <br />Date Recd. <br />Time Recd. <br />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 />F_ <br />3 x.,11 t✓-, A %t i <br />1f, </ <br />1. Sample Type: Air Watery Soil Other (specify): <br />2. Analysis — Test series requested: `--r { - i <br />3. <br />Field Data — Preservation: %L ' S ��76 �jf��''� L' Z % g 0�e "'S c— <br />Iii .'wx 40" --,1 <br />4. Date analysis required by (if not Holding Time): _ <br />5. Special handling conditions or other instructions: <br />b. Invalidating circumstances? If YES initial <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( <br />QAC <br />) and explain below. <br />) If NO, explain: <br />Date <br />