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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM ''. <br />Sample Submittal - S g t <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cason City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date xd r/ Time 113 Collected By 4-1 " e-1 'may <br />Field Custodian r.. ?.? <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />a.v?acr vu-aiac aicauriuvu <br /> - R i <br />T <br />.e rr?? <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br />ff '0 P/ <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - Test series requested: 7-a 4 1 <br />3. Field Data - Preservation: ?•#/ yy '...t- #-?' ??rfgr,. ?.5 ` <br />l? f,?7 'r.'` '"'?.. ,L r.,? L _ ??y ?7 mss..- .J'::?? -'c. ? w4.-• r, /f #. f `l , / (y?1?'? /'?J ii d?.?r LfirwR-? <br />41, <br />4. Date analysis required by (if not Holding Time): ate' <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 />( y ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES <br />QAC <br />) NO ( ) If NO, explain: <br />Date <br />.e <br />.... <br />- e