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Ih.VLLCC <br />JHH WC 0 III* IUU <br />' -, <br />YtsB.4 <br />_ <br />� <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal + ` S :$tS4 <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />Delivered By <br />Received By <br />Date Recd. <br />QAC <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S i f` - Lab. No.(s) <br />Sample Date 1" / Time #r) f ;) Date Data Entered <br />Collected By .. '1" �' c ti t Data Entry By <br />Field Custodian ; ► {' '. ./c ..1 <br />Laboratory Destination if not Cotter: <br />. 3 o2 <br />Time Recd. <br />1. Sample Type: Air Water f Soil Other (specify): <br />b. Analysis - Test series requested: ic <br />3. Field Data - Preservation: 7 /9• f ` ` 4 1,6 6 5 f f` ?''� :- ' 2 Z 2-. t-. 5 4. Jr s t <br />r j ;t ♦' y ' t' t 7 rr � 4 f� / . / f � + � t r 3 ..... j 1 (1 /i` ! f f, i )3 a` .) e .I•,,-. t /1.1c <br />1, 2 S �.- r,f ,�'7 r!.!t �J < •� n.r f �Cs +�Y W� + t`. / "7 f. 'Jt <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: ( • P //00- ' / 4 5 r Z <br />l <br />t / +'' ..) •, -.;y .«� ( C 4 / / fi r ,0rye` i C' <br />I ' .. <br />( <br />, �/ ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />Date <br />