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COTTER CORPORATION SAMPLE SUBMITTAL AND. TRACKING FORM <br />Sample Submittal ?`r3 S ISS44 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 812r^115 Cation City, CO 81215 <br />Sample LocJID No. _ 3 + Lab. No.(s) _ <br />Sample Date Time <br />rae :L yam.," .. <br />Collected By z°- •- ? ' <br />Field Custodian .= r"?» C, <br />Delivered By <br />Received By <br />Date. Recd. <br />Time Recd. <br />.1. Sample T p Air Water _ <br />2. Analysis - Test series requested: <br />v <br />aau <br />a, vu-ouc ucauuru <br />o <br />u <br />, <br />? / <br />// <br />/ <br /> <br /> <br />T ? yT f ff-w <br />3. Field Data - Preservation: <br />re - f . <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />r Soil Other (specify): <br /> <br /> <br />7' - ems. 5- 3 <br />J / J'? /fr E'J-w 7 C3... .' .. it <br />4. Date analysis required b' <br />(if not Holding Time): _ <br />y1i <br />5. Special handling conditions or other instructions: <br />b. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: . <br />Sample valid? YES { ) NO ( ) It NO, explain: <br />QAC Date <br />f <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />