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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACW.G FORM <br />Sample Submittal ? ?? J <br />C: P.O. Box 1750 S: P.O. Box 1750 P.O. Box 700 <br />Canon City, CO 81215 Cation City, CO 81215 -1: Nucla, CO 81424 <br />Sample Loc./ID No. o jr s 001A Lab. No.(s) <br />Sample Date / z-' J 7- j/-a? ? a. '? Date Data Entered <br />Collected By Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />f.• ' ?' - <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br /> <br /> <br />1 <br /> 115 <br /> <br />A,Rs <br />f <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: r4 4A: <br />3. Field Data - Preservation: 0. <br />r.•.?/ ; ?.' ; ! S S r`:'if •*1 f.. f? ... fc t <br />L Z?f <br />4. DaL analysis required by (if not Holding Tigre): <br />5. 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 <br />Date <br />_ PPAP 99 of 99