Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal r •� s27021 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />C. P.O. Box 1750 Nucla, CO 81424 <br />Canon City, CO 81215 Caiion City, CO 81215 <br />Sample Loc. /ID No. Lab. No-(s) <br />Sample Date ' Lo 0 Time '� 5 Data Entered <br />Collected By b �P'^'t G I- Data Entry By <br />Field Custodian & 6 7 r Laboratory Destination if not Cotter:: <br />Cotter Off -Site Destination " , <br />:2 JT 3 <br />Delivered By �+ + <br />'`� I _ , {�,• f; G Q, <br />Received By j <br />Date Recd. � —. <br />Time Recd. <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: �5 3 <br />° <br />3. Field Data — Preservation: <br />z- <br />4. Date analysis required by (if not Bolding Time): <br />5. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS — Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( <br />) and explain below. <br />) If NO, explain: <br />QAC Date <br />