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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />527 <br />:I S 2 <br />Sample Submittal , <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 Nucia, CO 81424 <br />Sample LocJID No. SV /9 L- Lab. No.(s) <br />Sample Date /-7 "/3.2 0/0 Time 42 V s <br />Collected By „fie P...-.? ?' <br />Field Custodian .[.y <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br />. <br />'VI <br />V V??CI y?l-aiac ?cauuaawu <br /> v <br /> <br /> <br />1. Sample Type: Air Water I Soil Other (specify): <br />2. Analysis - Test series requested: 4 <br />t., A <br />3. Field Data - Preservation: <br />r r..' s Q rd,,. cJ`• Al. g 2 5 - <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