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COTTER CORPORATION SAMPLE- SUBMITTAL AND TRACKING FORM <br />Sample Submittal 2.5.673 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City,. CO 812.15 Nucla, CO 81424 <br />Sample, .oc./ID No. . Ar <br />c? <br />Simple Date - 31 2 it// Time <br />Collected By / '=s T.< «? ''.` t'? a?% <br />Field Custodian" <br />Te6vered By <br />J( C. Received By <br />Date Recd. <br />' Time Recd. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry. By <br />Laboratory Destination if not Cotter: <br /> <br />L <br />L <br />Cf <br />LV s? ¦scnwuo¦¦vu <br />Vaa-va <br />?.?! r <br />y <br />? <br />- y <br /> <br /> <br />0 Il -tc1?. <br />• Je..._ <br />- 1. Sample Type: Air Water Soil Other (specify): H <br />1-/ Analysis- Test series requested: L f 3 <br />3. Field Data - Preservation: <br />c <br />J <br />F' <br />4. <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: ` <br />f" <br />( r::: 7 <br />Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC Date` <br />Date analysis required by (if not Holding Time):