Laserfiche WebLink
i <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11; ? 26438 ?T <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Callon City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. _Y W L4 /1 . Lab. No.(s) <br />Sample Date ?/' 9" v?J Time Date Data Entered <br />Collected By del?! ?--?? Data Entry By <br />Field Custodian n?? ?P.?-.v r . u'%- Laboratory Destination if not Cotter: <br />C tt <br />Delivered By <br />Received By <br />Date Recd. <br />Time Reed. <br />JJ ?o er Off-Site Destination <br /> <br /> - C. <br /> <br />O? <br />?N <br />1. Sample Type: Air Water 3 Soil Other (specify): <br />2. Analysis - Test series requested; c?e 04 T <br />3. Field Data - Preservation: ?-7 Q z} C4 <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 29 of 30