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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal :' 5 2 5 2 8 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./Ill No. ??- Lab. No.(s) <br />Sample Date h/ Time Date Data Entered <br />Collected By / r° .V e u- Data Entry By <br />Field Custodian . r,N?? Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />?J ^?l..Vl6C1 <br />?J f I?NNL Vll-.]/tc UcallUaJJI+?+/ <br />?A/CAC ? L.?__b <br /> <br /> <br /> <br />e r <br />1. Sample Type: Air Water Soil _ <br />2. Analysis - Test series requested: (n' u <br />o c? ,o <br />3. Field Data - Preservation: <br />y_? <br />?I i<P _ J- l /(7rL.{ I. ICJ` O. S? Z 1"4 <br />4. Date analysis required by (if not Holding Time): _ <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? It YEN 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 Date <br />Other (specify): <br />7L C <br />) and explain below.