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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />527 <br />Sample Submittal ? -- <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700. <br />Canon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s). <br />Sample LocJiD No. <br />Sample Date Time `- <br />14- <br />Collected By <br />Field Custodian t? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />I.OLLC[ Vla?Qlsc a???ar¦aar r¦v.. <br /> <br />? q. ?? 2 . ?-•t' t19. <br />1 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />I"ter' tt L- r?pr i 1 . <br />f <br />p 01 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: <br />.4- <br />& <br />3. Field Data - Preservation: <br />lie <br />4. Date analysis required by (if not Holding Time): Y y <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? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br /> <br /> <br />and explain below.: