Laserfiche WebLink
_uL«1 <br />f - S1te D eshnation <br />, 304 �Q -' <br />/ ff .)-_ <br />F.0,-/E, <br />So <br />S 3-�1( <br />r�o.1� <br />- < <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 5 25768 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />S tJ <br />Sample Loc./ID No. /3 d 5 <br />Sample Date S - 2 - ? 4 - ' f/ Time ! o : / S -_ <br />Collected By 1 v (0 7P.-c ,✓ c .�. <br />Field Custodian /-So( 7 � z .� <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Of ' ' <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />5. / ` <: . :ir G t7I /oc: c. <br />M <br />Z3 73 e /f (P' ‘r <br />%• pZ6o2 <br />: per. <br />" . r <br />1. Sample Type: Air Water / Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: Tw 7, 9/ 7, S t .30/ (-e s > ' <br />r <br />ti.vs = 0"•(1. f Z. S - c) i..s i z c i 5 L f'" f7/il /a. 7. S - <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 />Page 18 of 20 <br />