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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 700 <br />Canon City, CO 81215 Canon City, CO.81215 Nucla, CO 81424 <br />Sample L oJID No. / 3 - Lab. 140-0) <br />Sample Date 7--20-17a// Time 31 <br />Collected By a ^`?" `f -ye <br />Field Custodian <br />Delivered By <br />Received By <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />r r <br />Date Recd. 119 AA <br />` JJ <br />~M ?r <br />Time Recd. f' <br />?h; 4^ <br />1. Sample Type: Air Water Soil Other (specify). . <br />2. Analysis - Test seties requested: +f <br />3. Field Data - Preservation:' <br />N <br />of <br />,2. - <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />.Y <br />6. Invalidating circumstances? If YES initial ( ) and explain below. 'r <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES <br />QAC <br />Date <br />y <br />,or <br />NO( ) If NO, explain: