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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal !'.!_1 Sf <br /> C: P.O.Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Cation City, CO $1215 Canon City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. J �L Lab. No.(s) <br /> Sample Date - - `1�C/ Time !Y Date Data Entered <br /> Collected By ll'-_7 14 e Data Entry By <br /> Field Custodian �� b �`^�`'°� 1 Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <br /> ,. Energy Laboratories, Inc. <br /> Delivered By '1 `% f` '"f,, ''` rt 2393 Salt Creek Hwy <br /> Received By � <br /> r ��ell Casper. WY 82601 <br /> Date Reed. CD <br /> Time Recd. <br /> 1. Sample Type: Air Water ! Soil Other (specify): <br /> 2. Analysis— Test series requested: { <br /> 3. Field Data—Preservation: c /`a�. �� , ? A/ Z <br /> 2 . <br /> 4. Date analysis required by (if not Holding Time): <br /> 5. 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 ( ) NO ( ) If NO, explain: <br /> QAC Date <br />