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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: . P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 704 <br />Canon City, CO 81215 Cation City, CO 81215 Nucla, CO 81424 <br />Sample Lee./ID No. f 7?#V - Lab. No.(s) <br />Sample Date 3' /? "•? 0/ f Thee : 4 S7 <br />o..?.,s C <br />Collected By '9'6e. <br />Field Custodian 46d fb / ?+oyA0 .® A , f <br /> <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Waters <br />2. Analysis - Test series requested: ` =t <br />Date Data Entered <br />Data Entry By <br />Laboratory Desti/n/attioon if not Cotter: <br />A14 eA4,,eA /Y <br />a` <br />Soil Other (specify): <br />497 <br />3. Field Data -Preservation: K• • 2 ^' e <br />I-e 0 <br />i <br />jMaalysis required by (if not Holding Time): <br />S. S dandling conditions or other Instructions: <br />6. Invalidating` stances? If YES initial ( and explain below., <br />I <br />OM?IENTS - Explanation of noted items: <br />i <br />eclc If additional attachments, <br />_QA Review: } <br />ter. <br />Sample valid? YES (. ) NO ( ) if NO, explain: <br />f. <br />QAC Date , <br />-- - <br />- -- - ----paw 26-0129'*----