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, 1 . ..M <br />4. I <br />I : ; <br />- -/ V <br />27 <br />Sample Loc./ID No. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal S 2SiSS <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Date 4"% " ". ;' f Time <br />Collected By / ,' -+4 <br />Date Recd. <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />0 / <br />a 5 Lab. No.(s) <br />f f , c _ _ <br />3. Field Data - Preservation: -. ( 1 ) 7 <br />//et 5 i b . VO i i. v 7 s <br />Date Data Entered <br />Data Entry By <br />Cotter <br />• <br />Time Recd. ` <br />1. Samgie Zype: Air *Tater ` Soil Other (specify): <br />2. Analysis - Test series requested:--t , r' <br />I <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />