Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal : :-: s27162 <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 />Sample Loc./ID No. / t L-j 4 17 Lab. No.(s) <br />Sample Date i 9 - 41 Time 0 d <br />Collected By "� . t nK ) <br />Field Custodian I:> <br />Cotter Off -Site Destination <br />Delivered By v 6 <br />Received By `! <br />Date Recd. <br />Date Data Entered <br />Data Entry By <br />La JWratory Destination if not Cotter: <br />,� Tom°•.! . V J <br />Time Recd. ;Pico <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: i `a & r{'. 2. <br />3. Fl�eld Data - Preservation: 7o c % o- 3 f ! •-i <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 ( ) 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 />Page 21 of 21 <br />