Laserfiche WebLink
C: P.O. Box 1750 <br />Callon City, CO 81215 <br />Sample LocJID I+in. CAI <br />Sample Date 4'- 11 - /a. Thne <br />Collected By AOC. 40 <br />Field Custodian fk) cam; y <br />Delivered By <br />Received By i de <br />kr,7d <br />Date Read. <br />Time Reed <br />1. Saeaple Type: Air <br />oil Other (specify): <br />2. Analysis - Test series requested: t /61 f <br />3. Field Data - Preservation: ro - • 8 c H 7.4' S C' n iiY G. 4 <br />fit re ed A ,J /46 IJ CA ' ` a . s Z. / 41 40 7. 53,40 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Cotter <br />Sample Submittal <br />ors <br />Off -Site Destination <br />S: P.O. Box 1150 <br />Cation City, CO 81215 <br />. ro S2E142 <br />iY- <br />N: P.O. Box 700 <br />Nscla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter: <br />I? 'i sy Lc. '‘OtC toe'ry J <br />(3.-1 r A. Lr/ 1 0I <br />A ' <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 9 of 10 <br />