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s <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2 S 4 2 9 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Callon City, CO 81215 Canon City, CO 81215 <br />Sample Loc./ID No. c �.� 11� Lab. No.(s) _. <br />Sample Date / - 7 fi IS � Time I K .1 0 0 <br />Collected By i4 - 7— <br />Field Custodian 1. 1 . , ..+ t <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />y� a.Jvaaoa <br />vu -vaw aresuuisa s <br />2 2 ols <br />.y <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />-. <br />1. Sample Type: Air Water--3— Soil Other (specify): <br />2. Analysis — Test series requested:.s <br />3. <br />4. <br />5. <br />Field Data — Preservation: <br />yr• i' 1l"• 4 <br />Date analysis required by (if not Bolding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS — Explanation of noted items: <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES { ) NO ( ) If NO, explain: <br />QAC <br />Date <br />