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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal a:� S Mis <br />C: P.O. Box 1750 3: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caf[on City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. _!; Gt/ / 7 %,I' I <-A Lab. No -(s) <br />Sample Date Time 1 12.f0 <br />Collected By � F� ( f± �' <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />%.v«cr <br />vu -vuc ucowuuwvu <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />el, , i r - <br />1. Sample Type: Air Water <br />y►� Soil Other (specify): <br />2. Analysis — Test series requested: f C�. lie <br />56 /17 3. Field Data — Preservatio n: <br />70 '�'� <br />Z"r i f•^ f f'i !r fry t,f f'✓ r �rl�''i ; �i <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 />Paae 33 of 37 <br />