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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sa ?ple $Rbmiftal as C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. -!? W {- <br />Sample Date - f) -''rTime <br />a <br />r <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />LUi.?Ci vil-o?ac a?caaaua?avu <br /> <br /> <br /> <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter:. <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />l <br />2. Analysis - Test series requested: 14 ??- <br />3. Field "Data -Preservation: <br />4. <br />5. <br />b. Invalidating circumstances? If YES Initial <br />COMMENTS - Explanation of noted items: <br />( /r) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( } NO ( } If NO, explain: <br />QAC <br />) and explain below. <br />Date <br /> <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: