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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Submittal <br />W <br />Sample Loc./ID No. � C A ((I I) <br />Sample Date / - '1 " 2 Time I -Z ' / 0 Date Data Entered <br />Collected By ie,, t.• r '-'n,t e. A ► Data Entry By <br />Field Custodian ` d c <br />` PA, ' + t. Laboratory Destination if not Cotter: <br />Cotter Off Site Destinat t A <2 ,li S ,' -, / `'' " ' 7 ^ `' <br />Delivered By 2 7 ' ' -' e - /7' ✓ " G.. // * , <br />Received By <br />Date Recd. <br />Time Recd. ' " r <br />a <br />1. Sample P Type: e: Air Water / l' ^ Soil Other (specify): <br />/ /J <br />-, / f <br />2. Analysis — Test series requested: ' %- c <br />3. Field Data — Preservation: r <br />r i f : f" - <br />0. f, L i=4 // & - 2 <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 />IL, '' s 21131 <br />iy- <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Page 8 of 8 <br />, / 1 �. <br />•h 0G <br />.. <br />I <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Submittal <br />W <br />Sample Loc./ID No. � C A ((I I) <br />Sample Date / - '1 " 2 Time I -Z ' / 0 Date Data Entered <br />Collected By ie,, t.• r '-'n,t e. A ► Data Entry By <br />Field Custodian ` d c <br />` PA, ' + t. Laboratory Destination if not Cotter: <br />Cotter Off Site Destinat t A <2 ,li S ,' -, / `'' " ' 7 ^ `' <br />Delivered By 2 7 ' ' -' e - /7' ✓ " G.. // * , <br />Received By <br />Date Recd. <br />Time Recd. ' " r <br />a <br />1. Sample P Type: e: Air Water / l' ^ Soil Other (specify): <br />/ /J <br />-, / f <br />2. Analysis — Test series requested: ' %- c <br />3. Field Data — Preservation: r <br />r i f : f" - <br />0. f, L i=4 // & - 2 <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 />IL, '' s 21131 <br />iy- <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Page 8 of 8 <br />