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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S ":' <br />C: P.O. Box 1750 S: P.O. Box 1750. N:. P.O. Box 700 <br />Canon City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date S . ,? . 2 c+ r Time 0 <br />Collected By , <br />Field Custodian 7111 <br />Cott Ott Sit Desti <br />Delivered By . <br />Received B. <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />er a nation <br /> <br />"``,,?'?'? J, `a •'? '-tom C <br /> `T 1(9- <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />,r f <br />4.. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />b. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />wr <br />( ) Check if additional attachments. <br />^t <br />QA Review: g'. . <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />