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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal !U0. <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O.Box 700 <br /> Cation City, CO 8121E Cation City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No._ i9 "'0 f�_ Lab.No.(s) <br /> Sample Date 0- 14 D Q Date Data Entered <br /> Collected By r' _. T s, t # Data Entry By <br /> Field Custodian =? ?�, T�sue. G „ s Laboratory Destination if not Cotter: <br /> Cotter'(") Off- ads~.-� .• /� <br /> Delivered By <br /> Received By ; <br /> Date Reed. <br /> Time Reed. .r <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis- Test series requested: / <br /> 3. Field Data-Preservation: -C j :>;`+ 4f =t <br /> 0. <br /> 4. Date analysis requireWby (if not 1�lding Time): <br /> S. Special handling conditions or odIvIr instructions: <br /> b. Invalidating circumstances? If YES initial( )and explain below. <br /> COMMENTS-Explanation of noted items: <br /> Y <br /> r^ <br /> ( y) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO( ) "NO,explain: <br /> QAC Date <br /> Pana 7 of R <br />