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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ? 2SS96 <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 - Time r? #?# <br />Collected By a ?? <br />Field Custodian ?,, s "'• ?? <br />Cotter Oft-Site Destination <br />:J `s?° r-•. <br />Delivered By <br />Received By j <br />Date Recd. <br />Time Recd 4" <br />^- ? <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />z' Of J* <br />t' ire <br />n <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />2.. Analysis - Test series requested: <br />3. Field Data -Preservation: c.c: M ?- <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) It NO, explain: <br />QAC Date <br />'Ic -in <br />.., ..., ?. ?.?'?4'.:.,._.+pia;s=:.'?.,ru??e:_?z-,,-....a......afa?raFa'?. 4c.Q ..e..,o?.::.. ?.-e^=?'Yr+?a"w?>,.;:?s?a'iis'?t]?t43fiu?aoti'v?'•^'-?]7f1?Obaa. _.:..i?-- ??e'?si?Yio"s, <br /> - "`?? i_ -?wCui- ? iGY: .!.--e --