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a,vaarr <br />Orr Si to <br />na On <br />i <br />g -3- +1 <br />f.rA ix <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample LocJID No. S �- 0 5 <br />Sample Date �" •2 Zcr/ Time / Z C/ S <br />Collected By 41 1 <br />�l <br />6 <br />Field Custodian b <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />fl 4 I t <br />3. , Field Data - Preservation: r• <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />K° SM <br />P.O. Box 1750 <br />N: P.O. Box 700 <br />Canon City, CO 81215 Nock, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: ..r G/�.�y► CrGjO 4 vr , e ✓ 5 A' C. <br />p ae... i y <br />Sample Type: Air Water ff Soil Other (specify): <br />Analysis - Test series requested: (ode / <br />4' x, 9 2 el A/ F 7 a 16 � ) - <br />c' <br />e45 z S <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 />) If NO, explain: <br />Date <br />Page 38 of 41 <br />