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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal a. 2s 25522 <br />C: P.O. Box 1750 ;. Ss P.O. Box 1750 N: P .O. Box 700 <br />Cation City, CO 81215 Y Canon City, CO 81215 Nucln, CO 81424 <br />a <br />Sample LocJID No. .. <br />Sample Date 1, '' /6 ' -?'/ i Time S+ S? <br />Collected By /1'a4" Field Custodian 8'r"^ '. •f ?v +, <br />Cotter Off-Site Destination <br />{ <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />"''Pk <br />Delivered By <br />Received By <br />Date Recd. /7 1 <br />'.: <br />Time Recd. _, . •+ <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: _ e-7 J-0 l <br />3. Field Data - Preservation: <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 <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? Y1KS ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />':'... ... :.:. .... -n-.??:' .... _..n.:. a..k:...L:r:-acv u..L.. .w.r.:: .y.: i....i.:. ?.a -...i?..Y.,?. ....a,u u.. _. a._... ?...... - <br />IA 3r9 <br />) and explain below. <br />