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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2 5 6 7 2 <br />C: P.O. Box 1750 S. P.O. Box 1750 N: P.O. Box 700 <br />81215 Nucla, CO 81424 <br />Canon City, CO 81215 r Canon Lab. City, No.CO(s) <br />??• <br />Sample Loc./ID No. W/ ? <br />Sample Date Time <br />Collected By 1Sn? ??.?-r??-'?? <br />Field Custodian )I d b ?:.??.? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />4. <br />5. <br />%.VttcC Vll'471?6 LW¦¦uoHVn <br /> <br /> <br />30 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />z TT Sample Type:. Air Water ?? Soil Other (specify): <br /> <br />Analysis - Test series requested: <br />o ?• <br />Field Data - Preservation: T <br />0 <br />1v Z. ( <br />LS? c? <br />-2, y <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />('?L ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) . If NO, explain: <br />QAC Date