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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />loft <br />Sample Submittal <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Cation City, CO 81215 <br />Sample Loc./ID No. ;' <br />Sample Date Time I f <br />Collected By <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />VpLLCf <br />V11'�7aLi LCA NUaaavu <br />r' <br />1. Sample Type: Air Water. <br />2. Analysis - Test series requested: <br />Lab. No.(s) <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />w r r! <br />a <br />Soil Other (specify): <br />3. Field Data - Preservation: (! �. ,f f 7.6 rT.. 4 Z 0.1 <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />b. Invalidating circumstances? If YES initial ( } and explain below. <br />COMMENTS - Explanation of noted items: <br />Y <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( NO ( ) If NO, explain: <br />QAC DaRF <br />