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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal IS-6 32 <br />C: PRO. Box 1,750 S: P.O. Boa 1750 N: P.O. Box 700 <br />CsHon City, CO 81215 Cadon.City, CO 81215 Nucla, CO 81424 <br />Sample LocJ1D No. <br />d/Time <br />Sample Date <br />Collected By o -rf-- ^,/ c <br />Field Custodian. trdc ..;? <br />Delivered By <br />Received. By <br />Date Reed. <br />Time Recd. <br />1. <br />2. <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />ur / G ? d ?d ? ? ?,c°JS P <br />q ?;? CrY PLC few <br />V -7 <br />r? <br />Sample Type: Air water ! Soil ?r Other. (specify): <br />Analysis - Test series requested: E?Q I <br />16 <br />3. 1 <br />4. Date 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: