Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal f ? S 25358 <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. Lab. No.(s) <br />Sample Date Time S? d 0 <br />Collected By '' :? ,... . ?. <br />Field Custodian %f <br />Delivered By <br />Received B <br />Date Recd. <br />Time Recd. <br />LV{.LCf vu•auc ycauua??un <br /> L?.A4 <br /> <br /> <br /> / ZL <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />?, Gds <br />(. <br />1. Sample Type: Air Water ( Soil Other (specify): <br />2. Analysis - Test series requested: Ur' c. N ! u rrl, r co /i I./ <br />r <br />70 <br />c: ?? i Y:?V .Sri 2 r <br />3. Field Data - Preservation: 7 7. <br />/L, 7 <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 />Page 17 of 20