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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :,"'.0,25486 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. /? 31A Lab. No.(s) <br />Sample Date 11-2- 3'2J/J Time <br />Collected By <br />Field Custodian /? TpNN ?' - <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br />Delivered By ?P .vC r? L'A <br />Received By <br />Date Recd. <br />Time Recd_ <br /> <br />1. Soil <br />Sample Type: Air Water Other (specify): <br />2. er <br />Analysis - Test series requested: <br /> rvation: T ,c <br />f??? <br />P 7 b ?? 868 C? S ?T s <br />3. ' <br />rese <br />Field Data - <br /> <br /> G f i uF /r f? /1/, z 2 Z L of <br /> ??, c 5"--..I9 <br />1L ?lt'? H <br /> ? <br />4. Date analysis required by (if not Holding Time): <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 />( X ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( } NO( ) If NO, explain: <br />QAC <br />Date <br />_.__._?a9e 22 of 23 _