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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal _ S 2 5 6 4 6 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215p Cation City, CO 81215 <br />Sample Loc./ID No. I.y Q. /'t e 7' ff Lab. No.(s) _ <br />Sample Date 3 2al Time 2 A-, <br />Collected By ?? o? ??'.•r.,. n <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />LLCI <br />? <br />. <br />V Vll-?71 LC LC3l11litUVL <br />?pf <br />? <br />I <br />' <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />t e.*,C,y L<Se?vG61l-v s <br />73`f3 <br /> <br />_ Ti <br />L4 ? i S <br />1. Sample Type: Air Water S Soil Other (specify): <br />2. Analysis - Test series requested:. <br />3. Field Data -Preservation: ?,? •? / . u d . Q ,Ct,!i` r <br />Cr Y <br />4. Date analysis required by (if not Holding Time): <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />--Rags 24 of 26 -