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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal till! S19636 <br />C: P.O. Box 1750 S: P.O. Boa 1750 <br />Cation City, CO 81215 Cation City, CO 81215 <br />Sample LocJID No. Lab. No.($) <br />..r <br />Sample Date T `2 -7 -2 -01/mme _ •' S <br />Collected By &'a4 ?.P.??? <br />Field' Custodian J7..7 4 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />. .. 1. <br />2. <br />3. <br />I <br />4. <br />5. <br />l.vIIer vu-.74aa•,rw?.uauvr <br /> <br /> <br />- -201 <br />c06 <br />. I' -?°k <br />Sample Type: Air Water <br />Analysis - Test series requested: <br /> <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 />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />7393 S"'li` L°re P, EC f?'i??. <br />Z G p <br />N: P.O. Boa 700 <br />Nucla, CO 81424 <br />'?, / <br />Soil <br />Other (specify): <br />. c.'?` ->:m.?.?.=Wia .?;?.me2'3•? . -.. ; .._. ?_? ., .. ,_. a- a ?. _ ? - -- _ _r?.?wl'?r' ..?.?.?•ter`?fss.?„ - - <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions:.