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t <br />4 ter ` <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :.? R 211, ' 61 <br />P.O. Box 1756 S: P.O. Box 1750 N: P.O. Box 700 <br />Cation CityX- O 81215 Cation City, CO 81215 Nucla, CO 81424 <br />Sample LocJID N.+ , -1 c' �er f'11- <br />1 .� <br />Sample Date iY Time �� • 0 J <br />Collected By /SO L f r <br />Field Custodian If T " ✓r rt el -It <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />vv «Cr <br />Vl['47�K LiiYYiMJL <br />j ct Jr <br />f <br />04, f ~r <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />1 <br />Laboratory Destination if not Cotter: <br />_ Z.. 4,,_...i� -_c <br />C`- <br />r� <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: j4 o Y (Tot-) <br />3. Field Data - Preservation: <br />s <br />w� <br />4. Date analysis required by (if not Holding Time): _ <br />S. Special handling conditions or other instructions: <br />5 6. Invalidati5g 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 <br />t <br />QAC <br />) NO ( ) If NO, explain: <br />Date <br />