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COTTER CORPORATION SAMPLE SUBMITTAL AND TRAM CtM FORM- <br /> Sample Submittal S 17712 <br /> C: P.O.Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Cafion City,CO 81215 Callon City,CO 81215 Nucla,CO 81424 <br /> Sample Loc./ID No. A0n c A--'r Lab. No.(s) <br /> Sample Date Time j'' y ' Date Data Entered <br /> Collected By ' rr �" ° Data Entry By <br /> Field Custodian Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination y .. <br /> Delivered By f r` f r r �� �' •° <br /> �-� J•I l ll °. l <br /> Received By � �'" uvu <br /> Date Reed. /0 ` <br /> Time Recd. ! <br /> 1. Sample Type: Air Water Soil Other(specify): <br /> 2. Analysis— Test series requested: I-C. <br /> 3. Field Data—Preservation: Z . <br /> l:f.r•• <br /> 4. Date analysis required by(if not Holding Time): <br /> S. 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 />