Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1'110 S 2s fll <br />C. P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cason City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. 1 &'-, 0 5 Lab. No.(s) <br />Sample Date /1 -2 Time Date Data Entered <br />Collected By A 7f -r r ?'C __?_??__ Data Entry By <br />Field Custodian /3 7o r.? r c! _ Laboratory Destination if not Cotter: <br />C <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />otter <br />J6 O11-01te Desimation <br /> <br />?23 <br />t <br />1. Sample Type, Air Water <br />2. Analysis - Test series requested: < <br />Other (specify): <br />3. Field Data - Preservation: y ;7- `1 99 (. • • Z' 5 ,.? w S s J/~ <br />_//- S if r'.aJ c? G L? S j s ` U. S - l Fi4 ?/? ? . ? . S .•?,t? <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 Date <br />4 <br />?N <br />T <br />Sail <br />4 <br />) and explain below. <br />Page 17 of 20