Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal i ; R Z 3 <br />C: P.O. Box 1750 S. P.O. Box 1750 <br />Canon City, CO 81215 N: Box 700 <br />Canon City, CO 81215 Nuc ucla, CO 81424 <br />Sample Loc./ID No. ?641A L.-/49 Lab. No.(s) <br />Sample Date ??' 4 J IWd Ti-I.. 2yO Date Data Entered <br />Collected By % T?r.-G f Data Entry By <br />Field Custodian Laboratory Destination if not Cotter: <br />Delivered By z 1) <br />Received By <br />Date Recd. <br />?A? <br />Time Recd. ,. <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested: ...,z <br />3. Field Data - Preservation: .5 S^ A/ 6y <br />d 2 <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 { ) 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 <br />Date <br />Page 32 of 40