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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittalyd 1 <br />C: P.O. Box 1750 S: P.O. Boa 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. Lab. No.(s) <br />r <br />Sample Date Time f 0 : t S <br />Collected By d oi?,?../c.? <br />Field Custodian A-50 f-2 ?P,?i??..i' <br />Site Desti t{ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Cotter <br />? ?,v,?s ` ?- no on <br />T e' it <br /> <br /> <br />S15 <br />Date Data Entered. <br />Data Entry By <br />Laboratory Destination/ if not otter: <br />4*/ 4 14 41 <br />3 Sr f'v? ?l? wr . <br />3 7 <br />sjw r. Z Z <br />P? <br />1. Sample Type: Air Water r Soil Other (specify): <br />2. Analysis- Test series requested: <br />.3. 'Field Data - Preserv tion: <br />ca 1. g -? °` p. S° L CUs ;2 <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.