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COTTER CORPORATION SAMPLE SUBMITTAL <br />Sample Submittal 11:2 S+#►#�!'�' <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />Sample Loc. /ID No. —� <br />Sample Date <br />Collected By <br />Field Custodian f' <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />♦ u�acr <br />vii-acac Lcauuaaauu <br />kz <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: _ <br />1 <br />1. Sample Type: Air Water 'Soil (specify): <br />2. Analysis — Test series requested: <br />3. Field Data — Preservation: Z. Co # 7• f '� <br />•i .� 0-40 <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 <br />COMMENTS — Explanation of noted Items: <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 12 of 16 <br />