Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal s' srml <br /> C. P.O. Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Cation City,CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No._ �� n Lab. No.(s) <br /> Sample Date t! -i �`''_ Time & - Date Data Entered <br /> Collected By _c Data Entry By <br /> Field Custodian `� f -�</ ` Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination Energy Laboratories, Inc. <br /> Delivered By ' ''' 2393 Salt Creek Hwy <br /> Received Bye". �� R �c-�- 1 Casper. WY 82601 <br /> Date Recd. t°�3 <br /> Time Recd. <br /> f, r <br /> 1. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: r` 1 <br /> 3. Field Data—Preservation: 77 <br /> t � r <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 /> Page 36 of 38 <br />