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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 111! S 255 19 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Caiion City, CO J?81215 ?I Caiion City, CO 81215 <br />Sample Loc./ID No. N ? 5 6 01A <br />4413-4. <br />Sample Date 7'VoTie to " <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />ff,,,//-V LAC[ ?,,.,,/y+^ V11?a71aG Y6D aaus1aayu/J` <br /> <br /> <br /> <br />Lab. No.(s) <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />C. <br />Al Sample Type: Air Water .3 Soil Other (specify): <br />Analysis - Test series requested: F'57 S <br />3. Field Duty- X.. eserv^ation: 3 " /Z I-//-- 'I e oc4. Date analysis required by (if not Holding Time): _ <br /> <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Revielir <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date / `•. <br />1^-' <br />r <br /> <br />Page 6 of 6 <br />) and explain below.