Laserfiche WebLink
COTTER 'CORP J N SAMPLE SUBMITTAL AND TRACKING FORM <br />am le Submittal -S219145 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Caflon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./1D No. P� Lab. No.(s) <br />Sample Date 3-? - Time I `� <br />Collected By <br />Field Custodian / - r:ti r• <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />�,vucr <br />vu-ouc ycauuauvu <br />3 <br />Z�1�s <br />10 41s- <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis — Test series requested: 4 x' " 2 <br />3. Field Data — Preservation: 7( `� —� �� % 44y 3 I j <br />f. %' r`' i .i A�� :i 7 71 <br />l r f/ '- /I <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instruction': <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 15 of 15 <br />