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4 <br />I <br />i <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S15642 <br />i <br />i <br />C: P.O: Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Cason City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. <br />Sample Date 3 '2 2 - toll Time /3 <br />Collected By ,6 Pte' A/4n #V i- <br />Field Custodian Is06 TP,Hc,4 <br />Delivered By <br />Received BY. <br />Date Recd. <br />Time Recd. <br />"tie[ Vaa'oaac y?paaaisaavu <br />c' <br />C. ? f <br />? <br /> <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: <br />3. <br />Field Data - <br />P /iv 5 e <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 Date <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />GI yS ?Z U ?- <br />p 6a <br />Soil . Other (specify): <br />!? 1 <br />) and explain below. <br />