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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORK. <br />Sample Submittal r S <br />C: P.O. Box 1750 S: RO. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. S4a S Lab. No.(s) <br />Sample Date :2 -07 -20 / Time <br />Collected By o' e-e` c ' <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a,vaacr vu-oua ?oauuauvu <br /> <br /> <br /> <br /> <br />Date Data Entered <br />Y <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />-. r <br />70, <br /> <br />1. Sample Type: Air Water l Soil Other (specify): <br />2. Analysis- Test series requested: C",A <br />3. Field. Dstu.- Preservation: •" 7.12'-?."a"? <br />Z2.2- 41 <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