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2 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample.Sabmittal tt's S <br />C: P.O. B 1750 V S: RO. Box 1750 k N: P.O. Bog 700 <br />Cafion'tity, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />.y: . <br />Sample Loc./ID No. Lab. No.(s) , <br />Sample Date l.a 2_ • 'l Time Date Data Entered <br />y y s?. <br />Collected By Data Entry B "' <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a-va?er vai-aiac Lc?uuraavu <br /> <br />?i,..{•???/iJG w ? )) t <br />("qtr Ps ?-G <br /> <br /> <br /> <br />o .? <br />a ? <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - Preserv tion:p? f?# ? p2,// Z 3 g "r s _ <br />a r' .A C :? z ?ti Q <br />G f A 'V) ;1 j ;z L I= r° I//,.. .? ?e rt/ <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 eplain below. <br />COMMENTS - Explanation of noted items: ^'- <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) if NO, explain: I