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} . COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .. S list" <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Cafion City, CO 81215 <br />Sample Loc./ID No. r Lab. No.(s) <br />Sample Date `� w` �� ` ! Time <br />Collected By <br />Field Custodian /- j <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1 <br />Sample Type: Air Water Soil Other (specify): <br />Analysis - Test series requested: ~ • A, <br />1. <br />2. <br />{..0 «Cf <br />V11�Ol�c llWaauif�l.ivuy <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 />el <br />f <br />3. Field Data - Preservation: �'�i} f �; • �x`� %' r 1 �* �.-- <br />J7 td <br />4. <br />5. <br />Date analysis required by (if not Holding Time): <br />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( <br />) If NO, explain: <br />QAC Date <br />