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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal I:2 S $ <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />(3 _ . <br />Sample Date i .,--: F Time 10.3 0 Date Data Entered <br />Collected By -,'? Data Entry By <br />Field Custodian .2,. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />„t= <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: (n / <br />3. Field Data — Preservation: y / 41 . 5 <br />C' !. • "t. f / 7-< ' e <br />j <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />S7(1 g . f � Lab. No.(s) <br />Laboratory Destination if not Cotter: <br />2. .j4 e G M4,y. <br />•'". ; {,, fi. 4/ Y. i 7 ( 0 l <br />1 '_ <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />QAC Date <br />. s f ,_ . x c. ;, t 4 <br />s <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />rage lo or zu <br />1.V66C1 <br />•aa aicoa►ua i1V7.11 <br />Ir <br />E;'' <br />' <br />'F <br />' <br />c 4 , <br />I <br />/ -: <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal I:2 S $ <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />(3 _ . <br />Sample Date i .,--: F Time 10.3 0 Date Data Entered <br />Collected By -,'? Data Entry By <br />Field Custodian .2,. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />„t= <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis — Test series requested: (n / <br />3. Field Data — Preservation: y / 41 . 5 <br />C' !. • "t. f / 7-< ' e <br />j <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />S7(1 g . f � Lab. No.(s) <br />Laboratory Destination if not Cotter: <br />2. .j4 e G M4,y. <br />•'". ; {,, fi. 4/ Y. i 7 ( 0 l <br />1 '_ <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />QAC Date <br />. s f ,_ . x c. ;, t 4 <br />s <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />rage lo or zu <br />