Laserfiche WebLink
P--.. <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal _ ; .�� 7667 <br />" C: P:O. Box 1750 S: P.O. Box 1750 N: P."O. Boa -700 <br />Callon City, CO 812,15 Canon City, CO 81215 Nucla; CO 81424 <br />_ W <br />•. �Ac AD No. A IV Lab. No.(s) <br />�- Sawle Date �'I " ! n ' / Tmue <br />4 ? , <br />17 1. 7 <br />its e- <br />00-Site DestintioB <br />4 <br />Date Data Entered, <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />Time Reiff.'`_.` <br />Ir:�? JL f►�� Water _� r'oil Other (specify): <br />1�Te" es requested: �•d <br />3• Fuld Data - ry tion: C r � C <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial { ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) Check H additional attachments. <br />QA Review: _ ... <br />,,ww-*--i`8am'"P6'valid? - YES( ) NO( ) If NO, explain: <br />QAC <br />Date <br />Page 8 of 8 <br />