Laserfiche WebLink
I.UILLCi O <br />Off Si to D <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Cafion City, CO 81215 <br />Sample Loc. /ID No. Sr r+,,geos <br />Sample Submittal <br />4/ <br />S: <br />Sample Date 'rime �,' I9- /2 ` 7,.11° <br />Collected By )304 - -'". -4 it r <br />Field Custodian 33 a 5 fo, .� c <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />2. Analysis — Test series requested: 1 6 fe <br />f sI2 <br />P.O. Box 1750 N: P.O. Box 700 <br />Cafion City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not C <br />14 lcs <br />39 S Scit (' e gle <br />c' 9) may. (red - 61 <br />j - 44 "4" oe'S <br />Water C Soil Other (specify): <br />3. Field Data — Preservation: r vV 1 2 , 0 / Si 7-D 2 .._,j��.3 r SW-r t ' <br />Y/ A S e c (a -+. 3.9/ z. S ei ' c /)fLt/je/. 4 0 , f� <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 20 of 21 <br />