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<br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 112 S 25576- <br />C: P.O. Box 1750 S: P.O Box 1750 N: P.O. Box 700. <br />Csiion City, CO 81215 Caifon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date Time <br />Collected By _l3QG <br />Field Custodian ? ,.•?..? 6 <br />Cotter :Aft Site Destination <br />Delivered ByfJ06 <br />Received By <br />Date Recd. <br />Time Recd. <br />6r <br />1 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />o P; c4 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: J'e <br />3. <br />4. <br />5. <br />Field Data - Preservation: <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 />Supple valid?. YES.( ) NO ( ) If NO, explain: <br />QAC Date. <br />Page 37 of 39 <br /> <br />Date analysis required by (if not Holding Time): <br />Special-handling conditions or other instructions: