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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />h, Sa41tilmittal ¢`z? S 2ss-39 <br />C: P.O.. Box 1750 S: P.O. Box 1750 N: P.O: Box 700 <br />Cafion City, CO11 Cafion City, CO 81215 Nucla, C0$1424 <br />Sample LocJID N Lab. No.(s) <br />Sample Date Time T 4 a Date Data Entered <br />Collected By - Data Entry By 1 <br />Field Custodian !` .t . c• , •?av c -_ Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time. Recd. <br />l.V«Cr VILI-01tc LMMUNUOLL <br /> f <br /> r <br />V <br /> <br /> <br /> <br />L Sample Type: Air Water <br />rr^^ Soil Other (specify): <br />2.. Analysis - Test series requested: !e <br />s <br />3 llield Data -Preservation: <br />T + L. i?r e?J?Y° 2 ?+ ! +?F,'.. f i..T^.CA 'C- l 4.4 1/.leis i? ) t: <br />4 45:11 *V 0// <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 <br />COMMENTS - Explanation of noted items: <br />) and explain below. <br />( , ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br /> <br />a <br />