Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1:) s ism <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 W -eL Lab. No.(s) <br />Sample Date Ss' -,b `1 010 Time 1.4 /S Date Data Entered <br />Collected By /3*? Data Entry By <br />Field Custodian A ?r.+.z. c..? Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />r? <br />Time Recd. <br />1. Sample Type: Air Water -L??'Soll Other (specify): <br />2. Analysis - Test series requested: f/4 ? cl0e j <br />011 <br />3. Field Data - Preservation: 17-6 j U Ce,?-?? .3 S Jt t ?n <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 31 of 37