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l <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal s S2 <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. - oo m - Lab. No.(s) <br />Sample Date A -/6 - /I, Time <br />Collected By .&.16 71a -I <br />Field Custodian gf) -� 1:7 ,1-11 <br />t'rnffn.- . Aft-Q.t. Tluctinotinn <br />Delivered By, <br />Received By <br />Date Recd. <br />Time Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if <br />not Cotter: <br />i�:J �", �rY�r.�✓ �yc'rzt-rte' �,�,�r�:,,; <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested:'' <br />3. Field Data — Preservation: / JL` 12 7 <br />I �f7ilrt .� % S fvr'- Q; 0?, 0f { Si? �4jt'�.Ej I'�k :�r+ :: .. fir%�' <br />,o v' <br />f �21 In _ qtr; sit : - 0 <br />4. <br />5. <br />Date analysis required by (if not Holding Time): _ <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( <br />) and explain below. <br />) If NO, explain: <br />QAC Date <br />