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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2 518 8 <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. .[2t 5 - (701A Lab. No.(s) <br />Sample Date 7 Z Time <br />Collected By 1 ?+ ,v -7Y <br />Field Custodian <br />Delivered By <br />Received <br />Date Rec . <br />Time Recd. <br />1. <br />2. <br />I.ULLUF VlL•J ILC UVauLQ{LVU <br /> <br /> <br />?J <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br />16 -1 <br />Sample Type: Air Water 1(Soil Other (specify): <br />*-'^?'' <br />Analysis - Test series requested. <br />3. Field Data - Preservation: > D ! /c> i . < . ?: <br />4. <br />5. <br />Date analysis required by (if not Holding Time): . <br />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 />.? - .._? _ _._ .. elkamlw Je 8 of 8 ,-?