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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORK <br />Sample Submittal i S <br />C: P.O. Box 1750 S: P.O. Box 1750 N:. P.O. Box 700 <br />Canon City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. S Lab. No.(s) <br />Sample Date z - ,? y rl Time <br />Collected By <br />Field, Custodian_'.+•^r-r' <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1.u?1.Cr <br />.nlr'Q'' te varo?ac ycaswawvu <br />r' f;. Z43, <br /> <br /> <br /> <br />1. Sample Type: Air Rater <br />2. Analysis - Test series requested: r( <br />3. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />235 T <br />. "r <br />soil <br />u ? <br />Other (specify): <br />Field Data; -Preservation: 7 Z, t 7. <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 <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 <br />) and explain below. <br />