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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal N'S I55 S <br />C: P.O. Box 1750 S P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 W Cafiou City, CO 81215 Naela, CO 81424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date "Jl b ...too' Time 0 Date Data Entered <br />Collected By '>6 Data Entry By <br />Field Custodian Am :t 1?...r. 4d Laboratory Destination if not Cotter: <br />C. <br />Delivered By :. <br />Received By <br />Date Recd. <br />Time Recd. <br />otter Off-Site Destination <br /> <br /> 41 <br /> <br /> 3J?f <br />+}w a"y}yJ te a?j o3,. <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: <br />... ly=r _3 , ._ <br />3. Field Data - Preservation: Z.. <br />v? <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 />ea <br />.,.._....,._ ??.:.. ?. „?:.-?_....y..e.:. - ._ .? - - - cam. _ -.?-_ .ye, _.:?•r? ?.,,r :? _ ...c