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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal I; S S 83 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc./ID No. ? to <br />Sample Date ",2 5 -140/ p Time <br />Collected By L y <br />Field Custodian ! Z <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />sZ y Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />V V?bCl L <br />Vl?'OILG UC?l1?lAl?V <br /> / <br /> <br /> <br /> <br /> <br /> <br />i (o, _ f , r <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: A? / ?_ ?? r? <br />3. Field Data - Preservation: / ?/ 7, CJ :? !? / • ?f Ei !„ .., ,: 5 ? C7 u ; A r r <br />Y r n f 4. 9 u f !'j <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 <br />COMMENTS - Explanation of noted items: <br />) and explain-below. <br />( ) ' c , ad tachme .. '' <br />y ? r <br />QA Review: <br />Sn le vlid'! YES ( ) NO( ) If NO, explain: <br />AC Date ,' 3•= ?.?};.- - <br />