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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal %1:°_ S Uses <br />C: P.O. Box 1759 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Callon City, CO 81215 Nncla, CO 81424 <br />Sample LocJID No. S Lab. No.(s) <br />Sample Date Time /V 41d <br />Collected By ?o%_,.<..• <br />Field Custodian Aa 4 72e, rs .7 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Reed. <br /> vla-0390 LMSUBUHUH <br /> <br /> <br /> <br /> <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination N not Cotter: <br />C P r La ? jai a T'a,. ? ?I ? L <br />Ise. <br />4 All, <br />/ Soil Other (specify): <br />3. Field Data -Preservation: A, 5 <br />5- L ell <br />Z114 7. S- <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: