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r • <br />r COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />;. Sample Submittal i t= q_2,,1"',S26 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 ,,? ?+ Cation City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Aydra. a t t r !!W e-1 - Lab. No-(s) <br />Sample Date 11, -2 .{' Time ?y <br />Collected By L?ry IV A/ c t f <br />Field Custodian i r,> ., tie <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />){ /L. V7?IGl (V,t{I l'J{{i L6D {!t{i LlV4 <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br /> <br /> E <br /> y <br />. ? <br />/ :' !'f <br />1. Sample Type: Air Water f=" Soil Other (specify): <br />2. Analysis - Test series requested: 4 ?.. <br />3. Field Data - Preservation: <br />TIC ??. 7~ <br />- i.l S „ / r t .. <br /> <br />4. ate analysis required by (if not Holding Time): _ <br />5. S Lial handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />( n ) Check if additional attachments. <br />P QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />s - <br />QAC Date zi? <br />,l <br /> <br />c.p ?, 5 1r t r: <br /> <br />) and explain below.