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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal _ No S 16 I <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Cason City, CO 81215 Callon City, CO 81215 <br />Sample Loc./ID No. _ IAI" ? - Lab. No-(s) <br />. Cotter <br />?p b ?i? .rtk a es <br />^! k . <br /> <br /> •23 • ? ?4g <br /> <br />Sample Date _3 1,2- "Tlme Date Data Entered <br />Collected By _ IC y di ?,?.?t -,' Data Entry By <br />Field Custodian e Z f?,,,-.?4 -? Laboratory Destination if not Cotter: <br />Oft-S't D ti lion ? `s o? e f' ? ? r S ?•'?' C , <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />je? <br />?- <br />f w •r?/ <br />Sample Type: Air Water l Soil Other (specify): <br />Analysis - Test series requested: jf ';? 442 <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 <br />COMMENTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( } If NO, explain: <br />QAC <br />) and explain below. <br />Date <br />N: P.O. Box 700 <br />. Nucla, CO 81424