Laserfiche WebLink
s` <br /> � S <br /> COTTE !0, PORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Salt e Submittal <br /> C: P.O. Box 1750 V S: P.O.Box 1750 N: P.O. Box 700 <br /> Canon City, CO 81214 Canon City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. `�u�' Lab. No.(s) <br /> Sample Date Time- / 3 Date Data Entered <br /> Collected By Data Entry By <br /> Field Custodian Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <br /> y l <br /> Delivered By /.t" P <br /> fr <br /> �. <br /> Received By <br /> Date Reed. <br /> Time Reed. <br /> 1. Sample Type: Air Water` Soil Other (specify): <br /> 2. Analysis— Test series requested: <br /> Ir <br /> !� r <br /> 3. Field Data—Preservation: c !' s7 1 <: <br /> 4. Date analysis required by (if not Holding Time): <br /> 5. Special handling conditions or other instructions: <br /> P <br /> 6. Invalidating circums ances? 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 14 of 14.. - <br />