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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />.C: P.O: Box 1750 S: RO. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No.?-tr . <br />Lab. No.(s) <br />Sample Date "-10- 20/1 Time 9:4/0 <br />Collected By S Q ..... ?? T_ <br />Field Custodian Iffe-4 ?C:n.T <br />Delivered ByAV OA' e, .z <br />Received-By /0"- <br />D ate Recd. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destin do/n if not Cotter: <br />?.? ?o d.? 4 A s P S C <br />Z3 q3 s ? r ?? l? ?i,,? <br />s.r? ?•? GrJ,S??. ? 2 ? 4? <br />Time Reed. <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis.- Test series requested: r4 6 Ise <br />3. Field Data - Preservation: r* y 7. V f ee,.r -'U g <br />AiZ-r* Elf. Y;Z G . Z _7 011j <br />I <br />? s <br />70 <br />analysis req...red by (if not Holding Time): <br />ai. <br />Special handling conditions or other instructions: <br />S. <br />6. In "` circumstances? If YES initial ( } and explain below. <br />:' COMMENTS - Explanation of noted items: <br />