Laserfiche WebLink
COTTER.CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br /> Sample Submittal f S 2 9 1 d <br /> C: P.O. Box 1750 S: P.O.Box 1750 N: P.O. Box 700 <br /> Cation City, CO 81215 Cation City, CO 81215 Nucla, CO 81424 <br /> Sample LocJID No. Lab.No.(s) <br /> Sample Date _//A 41, !1 Time- 1 Y 1 S;' Date Data Entered <br /> Collected By Data Entry By <br /> Field Custodian / Laboratory Destination if not Cotter: <br /> Cotter Oft-Site Destination <br /> Delivered By "l r ,� f /�= l.� j F, / ell <br /> 1 J <br /> Received By f t { r';, <br /> -- <br /> Date Recd. <br /> Time Recd. <br /> I. Sample Type: Air Water Soil Other (specify): <br /> 2. Analysis— Test series requested: <br /> 3. Field Data —Preservation: <br /> �/ ! jj l �� 7 &4 <br /> 4. Date analysis required by (if not Bolding 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 /> t <br /> ( ) Check if additional attachments. <br /> QA Review: <br /> Sample valid? YES ( ) NO ( ) If NO,explain: <br /> Y+ <br /> QAC Date <br /> Panes 16 of 16 <br />