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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FOOL <br />Sample Submittal ?' S IS604 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Cation City, CO 81215 Nucla, CO 81424 <br />Sample L.ocJID No. 2(c/ 13 Lab. No.(s) <br />?j t+ <br />Sample Date .2 ' 40 :? • Time <br />.Ft . <br />Collected By <br />'-"? ?•' <br />Field Custodian f f» .tip <br />Delivered By <br />Received By <br />Date Recd. <br />Time. Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destinatign if not Cotter: <br />{t'`I`."• '.i}r, ?f? i." /'A. ?' fJ ,yew.. <br /> <br />r. ' <br />1. Sample Type: Air Water ' Soil Other (specify): <br />2. Analysis - Test series requested: <br />E? <br />3. Field Data - Preservation: c .pL~ *1 A - p1 ^x S ems, , 6A 15 if-1k4. OIL/ '2 4 0 '40 t? . ? ? L. ?"Y,'? .l ?3? ?t? 0:2 <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 />a,us?er vii-oiac irca?auauvn <br />ZILL <br /> <br /> <br /> <br />QAC Date