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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample. Submittal --N !-S2 6 311 <br />C: P.O: Boa 1750 S: P.O. Box 1750. N: P.O. Box 700 Cadon City, CO 81215 Canon City, CO 81215 Nncla, CO 81424 <br />Sample LocJID No.j? - Lab. No.(s) <br />Sample Date 1 ? a' Time <br />Collected By ?E+'•+?a?z <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br />Epp- <br />Sample Type: Air Water f Soil Other (spec*): <br />Analysis - Test series requested: <br />?16- _.?. <br />Field Data - Preservation: <br />o.?.? <br /><-A. <br />4. Date analysis required by (if not Holding Time): <br />5.. Special handling conditions or other instructions: <br />6, gvaldating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) . Check if additional attachments. <br />QA Refiiew: <br />Sample valid? YES { ) NO ( ) If NO, explain: <br />Date <br />j QAC <br />36b - <br />o