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<br />COTTER CORPORATION .SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal Nn M667 <br />C: P.O. Box 1758 S: P.O. Box 1150 N: P.O. Box 700 <br />Canon City, CO 81215 Cailon City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. <br />Sample Date Mme Z I4 <br />i <br />I Collected By A,!( <br />Field Custodian ??.r•? <br />AM OLD T?r1??6?? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />4. <br />5. <br />a.va?er vn-?uc annwn?wva <br /> <br /> <br /> <br /> YS <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination? if not Cotter: <br />io <br />S ?I'K Z' <br /> <br />Sample Type: Air Water Soil Other (specify): <br />Analysis- Test series. requested: <br />Field Data -Preservation: ot- S? 7 7f 2 el u S L S " <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />j <br />60 Invalidating circumstances? If YES initial ( ) and explain below. <br />j <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Semple valid? YES ( ) NO (. ) . If NO, explain: