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`....r <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2` $2 <br />C: P.O. Box 1750 S: P.O. Box 1750 N:. P.O. Box 700 <br />CaOon City, CO 81215 CaOou City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No.. JAJ Z L Lab. No.(s) <br />s j. <br />Sample Date , t f Time J Date Data Entered <br />/ -?'?" <br />Data Entry By <br />Collected By - ''-•'`'' c <br />Laboratory Destination if not Cotter: <br />Id Cnsr,.. <br />in ?. its Z r =' ! r: s. ` "~•.? c, <br />t Off. Sit e <br />Destation <br /> <br /> Delivered By <br /> <br />' Received By <br /> <br /> Date Recd. <br /> Time Recd. <br />Cotter r' <br /> <br /> <br />N , <br /> <br />r (n, <br />v <br /> <br />1. Sample e• Air Water Soil other (specify): <br />2. An, y is Tet??equested: 3., FieWDIt? $reservatti+ <br />4. .:Date analysis required by (if not Holding Time): '. 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: <br />QAC Date