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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING' FORM <br />Sample Submittal .+_ S$# <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Cafion City, C0.81215 Nucla, CO 81424 <br />Sammple L ocJID No. 6el Lab. No.(s) _ <br />Sample Date .240 <br />Collected By 1 ? 11"-"w el 'n w <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a,oaaer vu wrc aicauuwavu <br /> <br /> <br /> IVA <br /> - <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Z,. 4 <br />r ? <br /> <br />1. Sample Type: Air Water Soil Other (specify): . <br />2. Analysis - Test seties requested: f•,. c <br />3. Field Data - Preservation:: r F Y '? <br />4. Date analysis required by (if not Bolding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES.initial ( ) and explain below..... COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES { ) NO ( ) If NO, explain: <br />QAC <br />Date <br /> <br />y,.. -. . _.... -?.;. ?..?6? ?l{ate'' YA:?i°i?a f''^ . ?.,. _ _ _._ _ _ -' _ __ _.'G???[2L+