Laserfiche WebLink
V <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal .1-2 ? 26357 <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. s(,cJ 17C' Lab. No.(s) <br />Sample Date A.; i& ' Tim 1-/ Q <br />^ <br />Collected By <br />rr <br />Field Custodian 1 fem. .. -^ <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />VVLLCC <br />_ <br />?? ?('• /v !• ..i: VIYJI LC I/C3LIUaL5VU <br /> <br />l ?v Pr S` 1. <br />1. <br /> <br /> <br />oV? <br />1. Sample Type: Air Water Soil / Other (specify))): <br />2. Analysis - Test series requested: 61 r 4 N ?? f ?-? S c ?a i ,? <br />3. Field Data - Preservation: 16.7 - ? ?•?? r '? '' F' Ge-s 4/.7 c . ot, <br />I? <br />4. <br />5. <br />Date analysis required by (if not Holding Time): _ <br />Special handling conditions or other instructions: <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />AJ <br />'G` <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( <br />) If NO, explain: <br />QAC <br />Date <br />Page 16 of 20