Laserfiche WebLink
8L Jo$n abed <br /> COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal Nk S/1702 <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. fl141' O Lab.No.(s) <br /> Sample Date ? -.3 -.01 of 6 Time /� /�4 Date Data Entered <br /> Collected By 4 j t•7174. 1 'r Data Entry By <br /> Field Custodian A.-- / -9rr t .4 r Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <• . 7 f:. <br /> Delivered By #.�. ,r f-F',i 6, 7 ? <br /> Received By (_ �� g g s >r". hi Y. 2 6 <br /> Date Recd. Vtfiti <br /> Time Recd. Q'. 3Y <br /> 1. Sample Type: Air Water 2 Soil Other(specify): <br /> 2. Analysis— Test series requested: r. 2- <br /> 3. <br /> 3. Field Data—Preservatiion:Ff-I ( /,-> `/ K. Ss "/ , /• ?��u «< '� $ <br /> 1 <br /> (; 4. 6i r" ;r t ? y t <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 />