Laserfiche WebLink
ArK COKPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal It"ry <br /> P.O. Box 1750 �.. <br /> Canon City, CO 81215 S. PO'Boa 1750 <br /> Canon City, CO$121 P 4*=700 <br /> 9--ta, CO 81424 <br /> Sample Loc./ID No. � i-C.r `-'S <br /> Lab. No.(s) <br /> •l <br /> Sample Date 5 - Time S-� <br /> Date Data Entered <br /> Collected By F"', /7,r._ ., , <br /> 'r T" Data Euti7:,)�:.. <br /> Field Custodian /� . z , <br /> ' Laboratory Destination If not Cotter: <br /> Cotter Of[-Site Destination <br /> Delivered By �'� — Energy Laboratories, Inc. <br /> 2393 Salt Creek Hwy <br /> Received By ,f f"=, Casper, WY 82601 <br /> Date Recd. <br /> Time Reed. <br /> 1• Sample Type: Air / 41 Soil <br /> pp Other (specify): <br /> 2. Analysis— Test series requested: !o <br /> 3. Field Data —Preservation: <br /> 4. Date analysis required by (if not Holding Time): i <br /> S. Special handling conditions or other instructions: <br /> 6. Invalidating circumstances? If YES initial <br /> and explain balow. <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 16 of 20 <br />