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COTTER CORPORATION SAMPLE SUBMITTAL AND. TRACKING FORM <br />Sample Submittal 11,12 S 2 5 5 6 8 <br />C: P.O. Box 1750 S: RO. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Cation City, CO 81215 Nucla; CO 81424 <br />Sample LocAD No. <br />Sample Date 1=)L S`-,j Q# Time <br />Collected Byoy?r? <br />Field Custodian T olv r-e At <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />w/ E/ . 44 1 C7, G ?ae I Q-r ZAt C <br />Delivered By tfr-+V e. & Rc.--o - <br />Received By CG S 12 ,k24 2, <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water +/ Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data Preservation: <br /> <br />S <br />?h/ '. 78,,.d! 3 rr <br />_v?•- If e"/ GA4 v j <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 explain below.. <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 />x of 39 <br />Page 35