Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal '12 <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O.Box 700 <br /> Canon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. �� Lab. No.(s) <br /> Sample Date '' Time 7 Date Data Entered <br /> Collected By = �.� r _ Data Entry By <br /> Field Custodian Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <br /> Delivered By <br /> Received By ` .' <br /> Date Recd. <br /> Time Recd. _4 <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: <br /> 3. Field Data—Preservation: ►`. ! C <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 /> n, <br /> t.1 QAC Date <br /> Page 8 of 8 <br />