Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 11, $ 25901 <br />N: P.O. Box 700 <br />Nucla, CO 81424 <br />C: P.O. Box 1750 S: P.O. Box 1750 <br />Callon City, CO 81215 a } Canon City, CO 81215 <br />Sample Loc.JID No. .S ' /`f , 4 Lab. No.(s) <br />Sample Date g - 0 1 - // Time / 0 : VS <br />Collected By 406 re..✓/4 G -+ <br />Field CestOdian 1302 f'.' *i✓ t ,v t <br />Cotter Off-Site Destination <br />Delivered By /1"; Q d/V'n f <br />Received By c, Ejr <br />Date Recd: 9 -3 / / <br />Time Recd. /Q .�..5� <br />1. Sample Type: Air Water l Soil <br />2. Analysis - Test series requested: 7 /e_ <br />Date Data Entered <br />Data Entry By <br />Labo story Destination not Cotter: <br />e.►4'P#"* d C- /G o. c (Bee s �...c <br />t rJ� fr Z 3 9 3 5 /t C c, <br />may. ZCQ/ I. <br />Other (specify): <br />3. Field Data - Preservation: r is: g /- 7 g 3 t; 2 /s - le 54,44 J G <br />r ' f Co ",1 273 L4 S ACIT s 3- . Fc pe„ /s - /c f 41/4/0 A. o...Q <br />/ L/' 1,2c 6_ u/,4,6'4/ a s , 1 / (/F; /L 4'f414z Se <br />4 , t L 2,s -d.. <br />4. Date analysis required by (if not Holding Time): <br />5. "puc1al handling conditions or other instructions: <br />6. invalidating circumstances? If YES initial ( ! ) and explain below. <br />COUNTS - Explanation of noted items: /1"1.0. ( v 4 - 1 /0 <br />( ck if add :attachments. <br />QA Raview: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC Date <br />Page 34 of 41 <br />