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‘1.0 ll• <br />tm-onv imiteunimuu <br />_ <br />..„. <br />i l::- <br />->- <br />' <br />6111. <br />Sample Loc./ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 268/12 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />1.4 <br />• <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />t'- Lab. No.(s) <br />Sample Date '7- 1 .2 J/ 11 2 0 Date Data Entered <br />Collected By 4;0 -, Data Entry By <br />Field Custodian / I •4* Laboratory Destination if not Cotter: <br />• : ( 7 <br />' <br />el 1 ,1 <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. <br />Analysis - Test series requested: , <br />7 48 ( i e <br />3. Field Data - Preservation: / 1 44. /Y. • , // 2 s 7 jr t. <br />4 ( i t //A/0 <br />IF" <br />rf" <br />Fee <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: •C, t :7;( , s .1 e /2. <br />) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />