Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 5 2 5 6 5 3 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Calton City, CO 81215 Nucla, CO 81424 <br />Sample LocJID No. Lab. No.(s) <br />Sample Date • / Z. U/ r Time - y <br />Collected By go ? i?- e^" <br />Field Custodian ,/Z <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />l.0[?Cf Vu-OUC ucauuaawu <br />r j 5l <br /> <br /> ow? <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not [Cotter: ?}- <br />LIZ Z, ;z <br /> <br />1. Sample Type: Air Water Soil Other (specify): <br />2. Analysis - Test series requested:a - ?? <br />3. <br />Field Data - Preservation: <br />0 -7 <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 <br />) NO( ) If NO, explain: <br />) and explain below. <br />QAC Date