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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACBING.,FORM <br />Sample Submittal f S1 <br />C: P.O. Box 1750 S: ,PO. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. 1AU F 15 Lab. No.(s) <br />Sample Date <br />Collected By b <br />Field Custodian d: yt <br />Delivered By <br />Rekeived By <br />'1 <br />Date• cd.. <br />Time Rec <br />V VIICI <br />111110119 1/C311na"UU <br />U: <br />Date Data Entered <br />Date Entry By <br />Laboratory Destination if not Cotter:_ <br />.' t.. -, ,.Nei -:" , <br />1. Sample Type: Air Water' ` Soil Other (s ect ): <br />.� � F fy <br />2. Analysis - Test series requfsted: �' b <br />3. Field Data --,Preservation: t- / • 33 t" L° %J .',j OF <br />4. Date analysis required by (If not Holding Time): { <br />5. Special handling conditions or other Instructions: <br />6. Invalidating circumstances? If YES initiafk. ) and explain below. <br />COMMENTS - Explanation of noted items: f- C)= <br />( ) Check if additional attachments. <br />QA Review: C- <br />pie val? YES ( ) NO( } If NO, explain: ° <br />t QAC Date <br />Page 25 of 26 <br />