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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal=- <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cafion City, CO 81215 Canon City, CO 81215 <br />Sample Loc-AD No.. i Lab. No.(s) <br />Sample Date + Time S- <br />Collected By e4- <br />Field Custodian A.. {.a1.... f .t, <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />?.,v?ca;a vaa-aaao art;euuV?wu <br /> <br /> <br /> <br /> <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: <br />4. <br />5. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />N: P.O. Box 700 <br />. Nucla, CO 81424 <br />" if <br />r?Of <br />Soil <br />Date analysis required by (if not Holding Time): _ <br />Special handling. conditions or other instructions: <br />t <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />) and explain below. <br />... 00-1 <br />( f ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES { ) NO ( ) If NO, explain: <br /> <br />QAC <br />Other (specify): <br />Date <br />R 34 f 3Fr <br />s-.