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COTTER CORPORATION SAMPLE SUBMITTAL AND. TRACKING FORM <br />Sample Submittal 1)11d s $ 16 z 6 - <br />C; P.O. Boa 1750 S: PO..Bos 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Cafion City; CO 81215 Nncla CO 81424 <br />Sample Loc./ID No. .? Lab. No.(s) <br />Sample Date "me <br />Collected By _ <br />Field Custodian Z'f=Z2- <br />Delivered By <br />Received B? <br />Date Recd. <br />Time Reed. <br />1. <br />2. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />?ar a I ?zeS , ,Z v c <br />1 31 5a.. rk e eh- Sample Type: Air Water ! Soil Other (specify): <br /> <br />Analysis.- Test series requested: <br />761 <br />3. Field Data - Preservation: ` ,. <br />4. D ft 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: <br />QAC. Date