Laserfiche WebLink
COTTA CONrOKATBM SAMrLE SI BmTrTAL 4ND TRACSING FORM <br />Sample submittal - N°_ 9 2 5 2 7 6 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />CaOon City, CO 81215 Canon City, CO 81215 Nucla, CO $1424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date j4' I S" 7d/Orime Date Data Entered <br />Collected By 1T r Data Entry By <br />Field Custodian Laboratory Destination H not Cotter: <br />Delivered By n:s Se 4 4_4 <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: _&'Z_ <br />3. Field Data -Preservation: ro-taij siT <br />fnim <br />4. <br />5. <br /> <br />Date analysis required by (if not Holding Time): <br />Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial <br />COMMENTS - Explanation of noted items: <br />) and explain below. <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />Page 27 of 29