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COTTER CORr%— ,UN SAIVIrLr, Ou"i-T,___•--- - - <br /> Sample Submitta�? <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 Cation City, CO 81215 <br /> Lab. No.(s) <br /> Sample Loc./ID No. <br /> Sample Date <br /> At ; Z,, Time Date Data Entered <br /> Data Entry By <br /> Collected By <br /> t r, Laboratory Destination if not Cotter: <br /> Field Custodian <br /> Off-Site Destination <br /> Cotter Jj <br /> 77 <br /> Delivered By <br /> Received By <br /> Date Reed. <br /> Time Reed. 'G . <br /> 1- Sample Type: Air <br /> Water Soil Other (specify): <br /> 2. Analysis- Test series requested: <br /> v tion: <br /> 3, Field Data-Preser a r <br /> -rr I j } , <br /> 4. Date analysis required by (if not Holding Time): <br /> 5. Special handling conditions or other instructions: <br /> lain below.ex <br /> 6. Invalidating circumstances? If YES initial ( ) and p <br /> COMMENTS -Explanation of noted items: <br /> ( �. ) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO ( ) If NO, explain: <br /> Date_ - <br /> QAC <br /> Page 13 of 13 <br />