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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal a :', S 22 <br /> C: P.O. Box 1750. S: P.O.Box 1750 N: P.O.Box 700 <br /> Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. 46e ^" v Lab. No.(s) <br /> Sample Date - e �� 0 Date Data Entered <br /> Collected By r � 4".,y A C r Data Entry By <br /> Field Custodian .9 e 1 T n ^ Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination Energy Laboratories, Inc. <br /> T ��� r 2393 Salt Creek Hwy. <br /> Delivered By � :a Casper, WY 82601 <br /> Received By <br /> Date Reed. <br /> Time Reed. <br /> 1. Sample Type: Air Water b Soil Other (specify): + <br /> 2. Analysis — Test series requested: I �- <br /> 3. Field Data—Preservation: /4~0 a �.— • { 79 &-5� `r <br /> 4. Date analysis required by (if not Bolding Time): <br /> 5. Special handling conditions or other instructions: <br /> 5. Invalidating circumstances? If YES initial ( ) and explain below. <br /> COMMENTS—Explanation of noted items: <br /> C' <br /> ( ) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YiES ( ) NO ( ) If NO,explain: 42 <br /> - a <br /> QAC { 'Dates <br />