Laserfiche WebLink
COTTER CORPORATION SAMPLE AL AND TRACKING FORM <br />Sample Submittal S 25295 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample LocJID No. P z S 001A - Lab. No.(s) <br />Sample Date ' ??'? u?J Time ?'o• "_r <br />Collected By <br />Field Custodian 16 r <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />.h/ L,U?Lr ??'// - / <br />/Y V?1??71?c Lc.7 aauw asvu <br />f!.. /V ?'i b G ?7 <br /> <br /> <br /> <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br /> <br /> <br /> a? <br />?r <br />1. Sample Type: Air Water / ~ Soil Other (specify): <br />2. Analysis - Test series requested: e, Q <br />3. Field Data -Preservation: l ?0. <br />,e- /70 <br />4. <br />5. <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 />36 <br />/1A <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />0 <br />?c <br />Date <br />Page 8 of 8