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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal s►`2 S 73 <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc./ID No. �� L <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Calton City, CO 81215 Nucla, CO 81424 <br />Sample Date Time _ 60 <br />Collected By - <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />i <br />{.. U&MIL <br />Vll'�11K 1/i31.IIIi�1VII <br />Feld � <br />ter- r 3 <br />�S D <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />rte,- -s f %" ex <br />jr r�1S ►" �� � <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - Test series requested: C ak . . <br />Data - Preservation: <br />R <br />io/ / <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />{ :a, Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />SN <br />� QAC DaC2 �� <br />Page 10 of 10 <br />