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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM„ <br />n: .. <br />., <br />• Sample Submittal S <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. t Lab. No.(s) <br />Sample Date Time l <br />Collected By C <br />Field Custodian 0' 4-- i <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />4. <br />5. <br />/ ?fVUl6Cr vu-Disc ?.cafa'a`?uw?.v.. <br /> <br /> o? <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />?.n. ` ? ? V if-.{- ?i f.;,7 f.f s' rr 'k l-'%, <br /> <br />Soil Other (specify): <br />Sample Type: Air Water __ D V <br />Analysis - Test series requested: <br />Field Data - Preservation: <br />P <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 <br />NO { ) If NO, explain: <br />QAC Date <br />) and explain below. <br />__Page. 36 a