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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal *,'2 S ZS418 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caiion qty, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Lab.No.(s) <br />Sample Date P 1 'e 1 -Time A 'f.6 "Date Data Entered <br />Collected By r Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />fy %,U k1G1- V11-171M VGa tlua&m ll <br /> <br /> l? <br /> <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: r <br />r <br />3. Field Data - Preservation:. f. Z f y ` <br />4. <br />5. <br />Date analysis required by (if not Holding Time): _ <br />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 />) and explain below. <br />QAC _ Date