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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . :' s 2 6 3 6 7 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. 7 l'/ // / Lab. No.(s) <br />Sample Date S- + / � ' / Time 9 <br />Collected By / 7F', er, <br />Field Custodian 1? c`. 7 ^ '1 r - r / <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Cotter Off-Site Destination 4 ; 1 r ,,^, 4 ti � 4 <br />-,,. ,« t Z 1 C <br />Delivered By /J) I r",4 r",4 1 / ,C w 1:::}. . 3 7 ? i c, 4 1.- le P A a /44, . <br />Received By 'ee c! / r'A At 4y-- ! 6 I ! f('' r� y '.i 6 0 ) <br />Date Recd. 5 O <br />Time Recd. <br />11 5 ,,,, r 1 — <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: . / �' / <br />3. Field Data - Preservation: r v • t • , 7' / (7' ti <i' . 3 3 � � l� S c r ` <br />r/•� s e ��., dr 3, ©sr_ /C II-AA/WO? <br />/.2c (U,=. -' ,4 4/o . ? 2 4 ".,�..,� /6-t17:: <br />/ /: 4 N Sv S ;� _ 0, se L Ur/' , Al 4- u4' ? . 5 .•�..� <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 />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />