Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal f" Is <br /> C: P.O. Box 1750 S: P.O.Box 1750 <br /> Cason City, CO 81215 N: P.O. Box 700 <br /> Canon City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. Lab. No.(s) <br /> Sample Date Time / �.' Date Data Entered <br /> Collected By <br /> Data Entry By <br /> Field Custodian 'r_.=.. 7 .� � ,x .- .:. �"' <br /> Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination e, ;`, 0 f _. C <br /> 01 <br /> � . <br /> Delivered By <br /> Received By p r" <br /> ` 7 � <br /> Date Reed. <br /> Time Reed. f . <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: �,<;A- / <br /> 3. Field Data—Preservation: 1 2. 7 7. � <br /> 4. Date analysis required by (if not Holding Time): <br /> 5. Special handling conditions or other instructions: <br /> 6. InvaIidating 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 Ilate r' L <br /> Page 14 of 15 <br />