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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 25 SAS <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. (4/ .r !; Lab. No.(s) <br />Sample Date 1 A d 4?' A/ Tlme? 5.? <br />Collected By r °-w.'? C = <br />Field Custodian <br />Cotter .Off-Site Destination <br />Delivered By At 11.- <br />Received By <br />f <br />k] Date Recd. <br />c: <br />Time Recd. <br />1. <br />2. <br />Sample Type: Air Water -j <br />Analysis - Test series requested: <br />Other (specify): <br />3'. Field Data - Preservation: 3 ! •,. '. c <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 />P <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: