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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal s 11,431 <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 />e" l 1 ;. <br />Sample Loc./ID No. > Lab. No.(s) <br />Sample Date ''Time f 1 S > ..Date Data Entered <br />Collected By Data Entry By <br />Field Custodian 'r"••? -y - ?? Laboratory Destination if not Cotter: <br />Delivered By . <br />Received By <br />Date Recd. <br />Time Recd. <br />4 V1?G3 <br />.,. c t ' V11?U1LG L?;DLIV OLIVL <br />rt, r . c [? a?i <br /> ` r <br /> ll <br /> <br /> <br /> <br /> <br /> <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: je <br />3. Field Data - Preservation: .Z ' ?? J-? => > l?• ' Lr 4 .7 i <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 />QAC <br />Date <br />ge 37 of 89 <br />) and explain below. <br />