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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ._' S 25314 <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.?a- /f «, r7) Lab. No.(s) <br />Sample Date G 1 20 /0 Time j f 5-0 <br />Collected By rr..?.-mac <br />Field Custodian ?C /Ze <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a.vuca vu-ouo a?ceuuauvu <br /> <br />' T • <J <br />,ti o <br /> <br /> ' l t" <br />.0 l4 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />.;r <br />Sample Type: Aar Water Soil Other (specify): <br />Analysis - Test series reggested: <br />16 1 /_? /Z 7. 2 S 1? ?.? z ?'•? ?• s c: 7 + ?7 <br />3. Field Data - Preservation: T" <br />4. Date analysis required by (if not Holding Time): _ <br />5. Special handling conditions or other instructions: <br />Invalidating circumstances? If YES initial ( } and explain below. <br />:::MiVIENTS,-.Explanation of noted items: <br /> <br />