Laserfiche WebLink
COTTER CORPORATION SAMPLE SU iit'TAL AND TRACKING FORM <br />Sample Submittal r1=11 SIMI <br />C: P.O. Box 1750 S: P.O. Boa 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Callon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. l✓ ' Lab. No.(s) <br />Sample Date j !J "Y Time P15— <br />Collected By <br />Field Custodian. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />a.v«V <br />vu-anc aRSa� <br />?r <br />.l <br />/usuvn <br />fr� <br />` <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />.. ,p i -. W le. 4 t 7 c.. <br />Z 31 ! <br />1. Sample Type: Air Water. _ Soil Other (specify): <br />2. Analysis — Test series requested: <br />3. Field Data —Preservation: <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? It 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 />r Date <br />Page 24 of 25 <br />