Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal 't S t74" <br /> l <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Canon City, CO 81;1 Callon City, CO 81215 Nacla, CO 81424 <br /> Sample Loc./ID No. Lab. No.(s) <br /> Sam <br /> le Date 4 f `' 11me t .y "f' :� Date Data Entered <br /> Collected By Data Entry By <br /> Field Custodian t =' ''lef 2 Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <br /> Delivered By <br /> Received By <br /> Date Recd. �' a <br /> Time Recd. a►p t .r <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: <br /> � J <br /> 3. Field Data—Preservation: f 1 ' y '� ' /-? <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 /> age r o <br />