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<br />COTTER 'CORPORATION SAMPLE SUBMITTAL AND TRACKING. FORM <br />Sample Submittal to S <br />C: P.O: Box 1750 P.O. Box 1750 <br />Canon city; CO 81215 Cafian city, CO 81215 <br />Sample Loc1ID No.'s Lab. No.(s) <br />Sample Date ? S,-2 O// Time ? t1 S'0 Date Data Entered <br />Collected By Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />'rAl C, <br />Cotter 0off-Site Destination .0 <br />sszz <br />'ouer j " wl"o , Y;_ <br />Delivered. By <br />Received By <br />Date Recd. fl. <br />'•`"' <br />Time Recd. <br />1. <br />2. <br />Sample Type: Air Water /Soil Other (specify): <br />Analysis - Test series requested: TO L /C l <br />O4 ? ??{/ 'ma`y ?`y • L <br />3. Field Data - Preservation: t <br />n !e i <br />5'. <br />V" 4 d 5 L df? SO <br />4. puke. analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />b. Invalidating circumstances? If YES initial ( ) and explain below. <br />C0MI0NTS - Explanation of noted items: <br />(_ Check if additional attachments. <br />QA Review: <br />Sample valid? "YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />