Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Canon City, CO 81215 �1 / <br />Sample Loc. /ID No. ( 6 <br />Sample Date /'1- Z / * I Time / 3 4 S — <br />Collected By /-:<() <br />Field Custodian ./ :t .n r -t 7 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />7 t f <br />Sample Type: Air Water ! Soi Other (specify): <br />Analysis – Test series requested: / <br />3. Field Data – Preservation: <br />'r.t : �. /20( <br />' f <br />y i <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 />COMMENTS – Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />Sample Submittal <br />S: <br />,, , <br />.1i s267a5 <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cot)er: <br />2 ; � 9?„ .S 7/ ( // <br />cr." fti l 7 r 1/ ./ <br />t; <br />< e <br />2 . <br />1 // / <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 7 of 7 <br />1. V«O1 <br />v./Li-any UV II1I tI1UU <br />/`, 6 12 <br />/ 4 1 . -1't r , <br />f r " /f <br />/ <br />,,f / <br />- 77 /�o h f, <br />r' <br />1-7-T-13 <br />'YS <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />C: P.O. Box 1750 <br />Canon City, CO 81215 �1 / <br />Sample Loc. /ID No. ( 6 <br />Sample Date /'1- Z / * I Time / 3 4 S — <br />Collected By /-:<() <br />Field Custodian ./ :t .n r -t 7 <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />7 t f <br />Sample Type: Air Water ! Soi Other (specify): <br />Analysis – Test series requested: / <br />3. Field Data – Preservation: <br />'r.t : �. /20( <br />' f <br />y i <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 />COMMENTS – Explanation of noted items: <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />QAC <br />Sample Submittal <br />S: <br />,, , <br />.1i s267a5 <br />P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cot)er: <br />2 ; � 9?„ .S 7/ ( // <br />cr." fti l 7 r 1/ ./ <br />t; <br />< e <br />2 . <br />1 // / <br />) and explain below. <br />) If NO, explain: <br />Date <br />Page 7 of 7 <br />