Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />N2 Sample Submittal S 2 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample Loc./ID No. /414400 Lab. No.(s) _ <br />Sample Date (o '? 1 Time Date Data Entered <br />Collected By ?•? ?? ' Data Entry By <br />Field Custodian r ^? • ??' Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />I.VGtCI ? <br />r i vu•Vatc uc?uuauJvu <br /> <br /> <br /> <br /> <br />"; <br />1. Sample Type. Air Water Soil Other (specify): <br />2. Analysis - Test series requested: le ;Z- <br />3. Field Data - Preservation: <br />y 1. s 2 . j Y _ , r 7 ? /, ' . •./ (, 6 .? 7 /c_•?c (1. Z /'1,?. <br />4. Dafe knalysis 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 />( ) Chcok if additional attachments. <br />QA Review: <br />Sample valid? YES ( } NO ( ) If NO, explain: <br />QAC ?-_ <br />-f .C •'?.i <br />-i.J <br />Date <br />N. P.O. Box 700 <br />Nucla, CO 81424 <br /> <br /> <br />Page 25 of 26