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F <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />( <br />Sample Submittal 4 S ISS46 <br />{ <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. __ 61-/ A& ell, I. <br />Sample Date L O'K 1 d/ 1 Time 1A : 0 <br />Collected By? =o ?' <br />Field Custodian !.. c tars,.- ,.?' <br />Delivered B3 <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water <br />2. Analysis -Test series requested: <br />?.u?icr vu•uuc ucaaiuauvu <br /> f <br /> <br /> <br />W1ov <br />3. Field Data - Preservat/ion:. ?? S ., .. a ?.,r 3 r. ~? <br />r 6!9 <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 />s ; Pzg .1 1:8 . <br />Lab. No.(s) <br />z <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />te, <br />-_4 Soil Other (specify): <br />