Laserfiche WebLink
i <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal <br />C: P.O. Box 1750 . S: P.O. Box 1750 <br />Canon City, CO 81215 Canon City, CO 81215 <br />Sample.Loc.JID NO.. " Lab. N6,(s) <br />Sample Date f -21:11 Time <br />Collected By Field Custodian 1a:7 <br /> <br /> <br />y W-V <br /> f. j <br />rte, <br />1. Sample Type: Air Water <br />2. Analysis - Test series requested: f <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />3. Field Data - Preservation: e4w? <br />1-1 <br />-P,,, <br />rr1. 'f? S C' ' 77,c..-) ....c .f./r . -5. 15 i z gl "7 O a r 1. ? .? L..... i '" ?` "' ,/ e 7 .,:-/ <br />.? J. z <br />4. Date analysis required by (if not Holding Time): <br />S. 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 <br /> <br />) If NO, explain: <br />QAC <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />i.... wry, a .e ??i? r ? ?•? <br />Soil Other (specify): <br />Date <br />pQgp 2 of 36 <br />3