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COTTER CORPORATION SAMPLE SUBMITTAL AID TRACKING FORM <br />SaIpple Submittal j ' S 251$ I <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Cason City, CO 81215 Nucla, CO 81424 <br />Sample Loc.1ID No. ' (AI of Lab. No.(s) <br />Sample Date 121 4"' Time £ Date Data Entered <br />r .,?,.?. -• Data Entry By <br />Collected By <br />% P Laboratory Destination if not Cotter: <br />Field Custa?, <br />?k Si D d tf ? ?•. r / ,? ?, <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Field Data - Preservation: <br />. - _ .. . / j <br />Cotter Off• to es as on <br /> <br />tNV ' t - <br /> <br />1. Sample Type: Air Water ?l Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. <br />4. <br />5. <br />:07 <br />ez' <br />0' 2 <br /> <br />q <br /> <br /> <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 /> <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: