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l.UILCr <br />WI .171 U►Cb UU <br />r' <br />_ ... <br />r}o - <br />1 S <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Cation City, CO 81215 <br />So li&ie Loc./ID No. ...5 fg /J <br />9.42. Time <br />eithested By 1.1 7 T ) ,./ <br />fleki ttatodisin ' '•�l.!1 .. <br />ltlnlied By <br />Received By <br />Date Ned. <br />Qitg <br />C�t <br />Sample Submittal <br />S: <br />P.O. Box 1750 N: P.O. Box 700 <br />Caiion City, CO 81215 Nnda, CO *Z424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cuter <br />41/ 14 El/ <br />1. Ssapple Type: Air Water L Soil Other (specify): <br />MO P& - Test series requested: ,J' <br />, lid Data - Preservation: , ^ �C <br />4. p 7. » 7 , r+ . �'; 99 0,f/eft s. <br />" . <br />Illsae analysis required by (if not Holding Time): <br />S. dial handling conditions or other instructions: <br />mating circumstances? If YES initial ( ) and explain below. <br />ANTS - Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( (j. NO ( ) If NO, explain: <br />Date <br />sy <br />