Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 'r"2 s25486 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Canon City, CO 81215 / Canon City, CO 81215 <br />Sample LocAD No. - N W (? Lab. No.(s) ____ <br />Sample Date Time , 3 y S Date Data Entered <br />Collected By T?^?w Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />LULLCi <br />?T lrr ?'" ? vurouc L?c?uLn uvu <br />?'C <br /> <br /> <br /> a? <br /> <br />N <br />1. Sample Type: Air Water. Soil Other (specify): <br />2. Analysis - Test series requested: 7-. / /Q <br />3. Field Data -Preservation: T • `g ?? ?? U s ?: r s <br />z L"' I <br /> <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 <br />COMMENTS - Explanation of noted items: <br />( /( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO( ) If NO, explain: <br />QAC <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />) and explain below. <br />Date <br />Page 23 of 23