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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal N2 S 2$676 <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. S A e 9 Lab. No.(s) <br /> Sample Date 2 -9-10/6 Time +3 ' l S Date Data Entered <br /> Collected By AL( / p 4/94^ Data Entry By <br /> Field Custodian A $ S 74%4/16 Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination y o G•, s _% c <br /> Delivered By 73 97 Sc ft ( e L, //„moi <br /> I <br /> Received By ev / w .�� rife py. S7 G U / <br /> Date Recd. et4 /6- <br /> Time <br /> 6Time Recd. to • �Q <br /> ,iGtA' <br /> 1. Sample Type: Air Water S Soil Other (specify): <br /> 2. Analysis - Test series requested: Ta S /t / <br /> 3. Field Data-Preservation: 7 "L 6. 0 /J # 7.20 (,.c/. 3t S fa. �a 1-, , `cr <br /> rf F er „I 2.95 t. -C 6. 1 r �. 0. 2 s- L f/1fl vUs 2/J <br /> (r u C,1 i.///io 1. 7 r',.,..,-1) a.2 s-L..(/F , _V. 5-4. !!AA HZ 5 (1 ,i <br /> 7}_ <br /> �. j- L. is( I/st/c. OH Zs (? <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 /> Page 16 of 17 <br />