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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Cation City,CO 81215 CaliOn City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. H 6 Lab. No.(s) <br /> Sample Date Time ; 5 (1'� Date Data Entered <br /> Collected By Data Entry By <br /> Field Custodian Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination , 1",. <br /> Delivered By �j f l f t - Z 7�^y 7 •'s �. , <br /> Received By f'. J[K �'' + IV y <br /> L. vy <br /> Date Recd. <br /> Time Recd. <br /> I. Sample Type: Air Water t1 Soil Other (specify): <br /> 2. Analysis— Test series requested: ' - <br /> r <br /> 3. Field Data—Preservation: + ' r .,,f"-' '`J, S 6 ! � ,.r, Z 6 Z,.47. <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 />