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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />t <br />38 <br />Sample Submittal i t S Z <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. C W- 6_-5 Lab. No.(s) <br />"I l <br />Sample Date Time 3 S <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> '. <br />Time Recd. "C-P-6 C54- <br /> / <br /> <br />1. l <br />Sample Type: Air Water Soil <br />Other (specify): <br /> _Analysis - Test series requested: ?? J ! <br /> ' o f `f <br />1. •7 / f <br /> <br /> <br />T f n <br />4di Bata. -Preservation: 1 <br />.7 ?' 1 4? ! ! .? <br /> <br />t- <br /> 0 /j <br />' <br />I <br /> 4. DiU 'Ainalysis required by (if not Holding Time): <br /> rectal handbag conditions or other instructions: <br /> <br /> <br /> 6. Invaidati'? instances? If YES initial ( ) and explain below. <br /> <br /> <br />' '0Fs' xs x <br />`` S .ample <br />V A .z <br />. Ilk <br />i - q r <br />?,ua?er <br />t :'. ,,.rte . ? :"' vu-?uc iIGDLiiiA?,VLL <br />•.L,. <br /> <br /> <br /> <br />If NO, explain: <br /> <br />Page 15 of 20