Laserfiche WebLink
9 JO 9 abed <br /> COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal N! S tiia'4 <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 Nucla, CO 81424 <br /> Sample Loc./ID No. An .' .4. C' L' Lab. No.(s) <br /> Sample Date 3 - ' ib Time 9. 00 Date Data Entered <br /> Collected By l t t r i:, f t Data Entry By <br /> Field Custodian I. • •+t9 t, r Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination „.:,. f L c t. , - r <br /> Delivered By : r ?`s +1.1 • y <br /> Received By ! f€ t ..43• f'r <br /> _s/- N� [r. y e <.j/ <br /> Date Recd. 3/4//6 <br /> Time Recd. - 3 t f <br /> 1. Sample Type: Air Water <br /> r f Soil Other (specify): <br /> 2. Analysis— Test series requested: Tel: A is <br /> 3. Field Data—Preservation: r-.6 /c. S /y 7 ov' .- ''. z f,7:4 = /. <br /> .> —25, i-!/l ) •ej" � , !', jab • /3 _ <br /> (I. Z . L It/ AN3, /1c.-' /T. r TTC' 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 /> ( ) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO ( ) If NO,explain: <br /> QAC Date <br />