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s <br />COTTER' CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />S <br />Sample Submittal <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. <br />Sample Date l; -- / 6 `/S _ Time . �� ' tl a <br />Collected By f? r- 1, Let -M r ,.4 � <br />Field Custodian e 6 1 e "'4t .? c•. f� <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />q <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: —'3'o e c f` r A 4r t,.( <br />3. Fiend Data — Preservation: ' rr %/. .3 �` fy. // r" . 179 �� ex r. • > `t._ <br />(p f i/lr�r 0, Q [9 <br />4. Date analysis required by (if not Holding Time): <br />5. 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 />t�rJ! <br />e)ur5VtI!r <br />`1�� <br />�3'i._... <br />�}0027-<0 <br />C, <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: —'3'o e c f` r A 4r t,.( <br />3. Fiend Data — Preservation: ' rr %/. .3 �` fy. // r" . 179 �� ex r. • > `t._ <br />(p f i/lr�r 0, Q [9 <br />4. Date analysis required by (if not Holding Time): <br />5. 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 />