Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal i S 29 <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Ca$on City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br /> Sample Loc./ID No. R Al— / rq Lab. No.(s) <br /> Sample Date �S ' Time / `/ F Date Data Entered <br /> Collected By Data Entry By <br /> Field Custodian =_ f,I., :,I Laboratory Destination if not Cotter: <br /> Cotter Off-Site Destination <br /> Delivered By <br /> Received By <br /> Date Reed. <br /> Time Reed. (d% <br /> 1. Sample Type: Air Water ? Soil Other (specify): <br /> 2. Analysis — Test series requested: <br /> 3. Field Data—Preservation:ul ��• rf �. �� I 1 <br /> 141 <br /> L � <br /> -- <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 /> ( ) C11ea if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO ( ) If NO, explain: <br /> -a <br /> QAC Date 113 �N <br /> v <br /> Page 14 of 14 <br />