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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ? 2U26 <br />C: P.O. Box 1750 S: P.07 Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. LabrNo.(s) <br />Sample Date l/ 1 Time J J ! ? '? Date Data Entered <br />Collected By Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />3. Field Data - Preservation; ?'? ti S y u f a <br />%-V&tC1 uwolt01lcaUOa U/UV <br /> <br /> <br /> t-'f <br /> <br />(1- <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <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 />( , ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: