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'If71 ??'. "?V ?Me: <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ','?. S 25 63 9 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Caflon City, CO 91215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample. LocJID No..? <br />Sample Date l - 22 .2 A// Time 11:30 <br />Collected By <br />Field Custodian 7 ? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />4. <br />S. <br />i <br />Sample Type: Air Water <br />Analysis ..Test series requested: e <br />Field Data - Preservation: <br />Lab. No.(s) <br />Date Date'Entered <br />Data Entry By <br />Laboratory Destination it not Cotter; <br />e: p P' f7?w ?r. <br />Soil Other (specify): <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 />{ <br /> <br />Date .analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: