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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />? <br />Sample Submittal i'to <br />M S?•1r <br />C: P.O. Box 1730 S: P.O. Box 1150 N: P.O. Boa 700 <br />Carton City, CO 81215 Carton City, CO 81215 Nucla,- CO 81424 <br />Sample Loc./ID No. Lab. Ne.(s) <br />Sample Date 32/9 "2111 Time 30, <br />Collected By d3e''F.•? <br />Field Custodian iCS4'C''^ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a. P <br /> <br />1. Sample Type: Air water f Soil Other (specify}: <br />2. Analysis - Test series requested: <br />3., 'IP'iield Oats - Preservation: <br /> <br />o•- /t e <br />S` <br />(,cam ?"? S <br />4.. Date analysis required by (if -not Doldlag Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( } and explain below. <br />COMNWjK.'I'S - Explanation.of noted.1tems: <br />( ) . Check if additional attachments. <br />QA Review:. . <br />Sample valid? YES ( } NO( ) If NO, explain: <br />QAC Date <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination-if not