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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :' s 2 5 2 2 6 <br />C: P.U. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caflon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. 1> r ? 0 ) //" Lab. No.(s) <br />Sample Date 9 " / -') ;1/6) Time Date Data Entered <br />Collected By Data Entry By <br />Laboratory Custodian y Destination if not Cotter: <br />/ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />?.v?aea vu-vnc ucauua?/ivu1 <br />L t.L <br /> ?r <br /> <br /> <br /> <br />1. Sample Type: Air Water ` Soil <br />2. Analysis - Test series requested: l./ <br />3. Field Data - <br />v- 1.7.6 <br /> <br />Other (specify): <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 <br />Date <br />8of8 _