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i' <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 2!` <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Caflon City, CO 81215 Carton City, CO 81215 <br />Sample. Loc.1ID No: '' , ??.,? Lab. No.(s) <br />Sample Date T -.20/// Time 10:00 <br />Collected ,By <br />?? <br />Field Custodian ,. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: <br />a. <br />v <br />«ca vii-ane ifesilaailon <br />y? <br />./ <br /> <br /> <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />f- <br />r rJ' <br />'i AJfr <br />_ Sol! Other (specify): <br />3. Field Data - Preservation: <br />f S <br />ILI <br />. . ?.• n. .`: .. <br />4. Date analysis required by (if not Holding Time):: <br />5. Special handling conditions or other instructions: ! ;z <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 { ) If NO, explain: <br />QAC Date _ <br />Page?31 of 36 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />