Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> '11 S <br /> Sample Submittal <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O.Box 7Q0 <br /> Cason City, CD 81215 Caiion City, CO $1215 Nucl oTO 91424 <br /> Lx/ - ,� Lab. No.(s) C_ <br /> Sample Loc./ID No. ) <br /> Sample Date rMe `5- Date Data Entered <br /> Data Entry By ' <br /> Collected By <br /> Field Custodian `'� f' t Laboratory Destination if not Cotter: }.a <br /> �t <br /> Cotter Off-Site Destination <br /> Delivered ByT., <br /> Received By <br /> Date Recd. <br /> Time Recd. <br /> 1. Sample Type: Air Water ; . $o Other (specify): <br /> 2. Analysis- Test series requested: <br /> 3. Field Data-Preservation: <br /> ce ; ems-, firs' tl. <br /> L_ ! - <br /> /1' a '' '� '• `v`�_ <br /> t - <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 <br /> Page 23 of 24 <br />