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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :2s 27321 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. —� W 0 Lab. No.(s) <br />Sample Date .2 - '/" l V Time r <br />Collected By &,4 P.. 4 CA <br />Field Custodian 12d <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. I C <br />Sample Type: Air Water 7 Soil Other (specify): <br />Analysis — Test series requested: -7-441-- f <br />L'���,,ULL�''LCJF <br />WWAX-011Z LGD61�Lu <br />-�uvu <br />r' <br />� 3U <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: p <br />1. <br />2. <br />3. <br />4. <br />S. <br />Field Data — Preservation: �G <br />Date analysis required by (if not Holding Time): <br />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 />/r /I' /' <br />) and explain below. <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />i <br />�s <br />