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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal s25451 <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. P' t 0 J 1A - Lab. No.(s) <br />M > <br />Sample Date d J Time f o <br />Collected By TP.vr?a? ?? <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br /> I..VLLVI Wit-Olt 11G3Lll14LIVll <br /> Tn .-,•.? -. .N ?? Z' j <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />ei S <br />4k~ <br />1. Sample Type: Air Water ff Soil Other (specify): <br />2. Analysis - Test series requested: S h /e ? _ <br />3. Field Data - Preservation: <br />W fir'"/7 HAM,, L 1 C- <br />7, C 7. ?? rz <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 />. ?' <br />c G ?? <br />COMMENTS - Explanation of noted items: Jr r <br />( ?( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC Date <br />C}la('4'ofte 21 of 21