Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal U! S25163 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc. /ID No. Se.ti - L L J Lab. No.(s) <br />Sample Date G - /t -2 /i Time /32 5 Date Data Entered <br />Collected By 1.3 ti 4 TP .v14 Data Entry By <br />Field Custodian/S0 S TCA. 4/4 -t. Laboratory Destination if not Cotter: <br />Cotter Off -Site Destination <br />Delivered By A I c / * - { " <br />Received By f P c/4 ,Y ied go(' C ( <br />Date Recd. q -11- 1 I 17 2 <br />Time Recd. Mg d 1" S CI° <br />1. Sample Type: Air Water .1 Soil Other (specify): <br />2. Analysis - Test series requested: (d 1 S <br />3. Field Data - Preservation: T o� ?• O / KO Alf)! ■6 L{ 5 e. -r S 4 <br />, /,1 s e 3 , 5 1 . "`"j / f"/¢' H4/ 0 <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 28 of 29 <br />