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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal " s26279 <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 Nucla, CO 81424 <br />Sample Loc./1D No. Lab. No.(s) <br />Sample Date 0/1') Time ;ko <br />Collected By / """ r <br />Field Custodian -)Ll'c_%.y.?? ?•-? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Reed. <br />LOLLCC Vu-Jt lc i VNLLJtauvu <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />li <br />?r <br />d <br />G 7'/ <br />1. Sample Type: Air _ Water Soil Other (specify): <br />2. Analysis- Test series requested: (0,eL <br />3. Field Data - Preservation: a- r?• ?? 2_ f? L ?/ u L s <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 <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 />Page.37...of_43_ <br /> <br />) and explain below.