Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal S tillS 6 0 <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O.Box 700 <br /> Canon City, CO 81215 Canon City, CO 81215 Nada, CO 81424 <br /> Sample Loc./ID No. b" 2 "1 Lab. No.(s) <br /> Sample Date I " % i '% Time 1 3 '? 3— <br /> Date Data Entered <br /> Cocted By 4 Data Entry By <br /> Field Custodian / r Laboratory Destination if not Cotter: <br /> ,401 <br /> Cotter Off-Site Destination It. . , f ;` i <br /> Delivered By - f` / !. ' ' r. / ' . 0 1 r r <br /> • <br /> Received By w /' i. ',�, J= , <br /> ,,Date Recd. <br /> Time Recd. I 172 et <br /> p � " <br /> 1. Sample Type: -'Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: r1 , 'e <br /> 3. Field Data—Preservation:f1, L /6 `' / 41 X, i f'- ,% S 7 c. 5 fly <br /> , , "! <br /> 7 .3 1 s-ac, z /_A <br /> r ,.7 ;i,'•,/, 2 , /1 i,,r/ ,h'7 5 C , /- <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 /> xak <br /> • <br /> ( ) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO ( ) If NO, explain: <br /> QAC Date -- <br /> Page 15 of 17 <br />