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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal R-2-5 63 8 <br />C: P .O. Box 1750 . S: P.O. Box 1750 <br />Canon City, CO 81215 Cai<on City, CO 81215 <br />Sample LocJID No. (4 Q D Z S Lab. No.(s) _ <br />Z- 22 - Time <br />Sample Date <br />Collected By o <br />Field Custodian a rp "? <br />Delivered. By <br />Received By <br />Date Ricd: <br />Time Recd. <br />Uosser M".7,1sc <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />ti G4 O/Q' ?ori f5" r', <br />-e e <br />c1+ "'4 / <br />Air Water % Soil Other (specify): <br />1. Sample Type: <br />2. Analysis Test series requested: <br />{r J V? " Imo' ! F Ll S Z S 6 4 <br />3. Field. Data -= Preservation: ? <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 explains below. <br />COMMENTS - Explanation of noted items: <br />i <br />C <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC Date <br />I <br />i <br />i <br />N: P.O. Box 700 <br />Nucla, CO 81424