Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal � _ ," S 2 ? 1 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />PL Lab. No.(s) <br />Sample Loc./ID No. �'�' B <br />Sample Date 9 'rs ' IJ Time <br />Collected By ' j624 <br />'E•'!`3''k -� <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />l..UILCI <br />L✓C, 4 <br />Vfl'Oarc aiwaauwaavw <br />r <br />F <br />C.✓ <br />:c.►S <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />C1 3 <br />C-c"r- e.�, WY 82-601 <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: <br />3. Field Data — Preservation: 77"L I `% • 7 <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 ( <br />QAC <br />I <br />) If NO, explain: <br />Date <br />-- age 10 o <br />