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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal ° S2S'n <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample LocJIDD No. <br />Sample Date el- 42 -2 "! /. Time <br />Collected By 466 6 '�•�✓ G."``' <br />Field Custodian Aft 6 •ai.✓r. <br />Cotter Ott -Site Destination <br />Delivered By <br />Received By <br />Date Recd. <br />Time Rtcd. <br />1 <br />ar ,e/ <br />j C601� <br />Air Water Soil <br />2. Analysis - Test series requested: ec, I <br />Sample Type: <br />Field Data - Preservation: <br />Wit - <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? ' YES ( ) NO ( <br />• <br />QAC <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Co r: <br />"re"? 14 4 001 S I/V (- <br />2 3I_3 4 7 e �C wcf'• <br />5 .) V 82602- <br />Other (specify): <br />4- r4'4/J3 <br />) and explain below. <br />) If NO, explain: <br />Page 16 of 20 <br />