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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 'N'2 s 2S427 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Caiion City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />4&- <br />Sample Loc./ID No. Lab.,No.(s) <br />Sample Date l/ Time Date Data Entered <br />Collected By. -? , L = ~ Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />VULICl VI1'OILC LCJ LIL7LG11iU <br />IVY <br /> <br /> <br /> <br />J <br />f'- 11 1 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: P <br />3. Field Data - Preservation: ' <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: <br />QAC Date