Laserfiche WebLink
I,.ORer <br />vll - c7RG 1/CD►1uA►lou <br />4 <br />O <br />7 14.- o F <br />C: P.O. Box 1750 S: <br />Canon City, CO 81215 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Loc. /ID No. P 4 7 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />Sample Date 9 -27 - /2. Time 13 5 5 Date Data Entered <br />Collected By 4t <94 L Data Entry By <br />Field Custodian 1S,-) 4 7-4 n G ., 7 Laboratory Destination if not Cotter: <br />Sample Submittal <br />• <br />1. Sample Type: Air Water CGS Soil Other (specify): <br />2. Analysis — Test series requested: Ili /G' <br />3. Field Data — Preservation: r° L i 5+-'7 ,) / 6. 7 7 c/- ZO CO s - r <br />P / n C t . 0 ) 1/.05/ c> _ ; • ; / _ N �.� 0 �. v v • 30 °J .7--t <br />U S <br />I G M / d, a v.&,.� i 1 L r 1 /6 4//64 / //Cid 2 u .J <br />L/;/ / L1 /./ /z 1 0L, 5 <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 ( <br />s26570 <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />• <br />Lab. No.(s) <br />el "4'5 5/ L S c).e C <br />2 3(43 ScJI -"` d /-7 <br />s f, 4./y ? G'o ( <br />) 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 <br />Date <br />Page 20 of 20 <br />