Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal . t? S 2 5 4 0 2 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. S&/ - 8L <br />Sample Date % ••1 i Time / 4 ' O <br />Collected By L7 /?.?.... <br />Field Custodian <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />4. <br />5. <br />LVitCi' U11-01M ky""U46Iun <br />r S <br /> <br /> <br /> (.Q-- <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />/ 4.., <br />/-1 0 r'0Vf <br />Sample Type: Air Wate 7 r L_ Soil Other (specify): <br />Analysis - Test series requested: ?.L /' -' TG 4 /,: J&/ <br />Field Data - Preservation: a <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? It 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 />Page 28 of 29