Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal Ni S 25433 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.U. Box 700 <br />Canon City, CO 81215 Canon My, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. L Lab. No.(s) <br />Sample Date ?' - "7 Time ?J J Date Data Entered <br />Collected By 1! / " j •? Data Entry By <br />Field Custodian - Laboratory Destination if not Cotter: <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br /> <br /> <br /> 1 o <br /> q <br /> <br />1. Sample Type: Air Water f ~ Soil <br />2. Analysis - Test series requested: / <br />3. Field Data - Preservation: ! 14 <br />8 <br />Other (specify): <br />v <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 ( ) 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 Date <br />x