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w«cr <br />lull-mix D estinat <br />f <br />f f <br />T —Jr 4.' <br />t4 £X-6 <br />ceism.A.4:13- <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1 �= S t 5$ S <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. ,' / 4- Lab. No.(s) <br />Sample Date 4 ` 6 - �2 lime 2 <br />Collected By 1 ?4_2 �, ;tr. ri c. 1 <br />Field Custodian /'s 6 -► ,q e .c , t Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />, /► <br />Sample Type: Mr Water I Soil Other (specify): <br />2. Analysis - Test series requested: (7, ‘It 1 <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 />70,,, , c <br />,� ` <br />7 q (�- +P P' Jt /7 4 � <br />("i y g ? ( (, I <br />d/ <br />3. Field Data - Preservation: T ' J Rye. 3 / A" 76 S 2 4 SO r. 7i s <br />• 5 - 4./ i s/ 4 .�/ <br />p, s - L lx NA/ a . <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 />Page 6 of 6 <br />