Laserfiche WebLink
Sample Submittal <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O.Boa 700 <br /> Cafion City, CO 81215 Canon City, CO 91215 Nucla, CO 81424 <br /> Sample Loc./ID No. S W fS Lab. No.(s) <br /> Sample Date Sr. !3 /4 Time ! / } Date Data Entered <br /> Collected By -'�^>R C-',,e 7 Data Entry By <br /> Field Custodian ,'Z, '(, l r", .�, ,- t Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination `�7 4 f " - s— <br /> Delivered By <br /> Received By <br /> Date Recd. 14 <br /> Time Recd. / <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: <br /> 3. Field Data—Preservation: i�. �� �•/�� f.', y S r �� s <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 /> Page 18 of 23 <br />