Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal 1:.�_ S 26114 <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 J Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc. /ID No. v l.� —�G- Lab. No.(s) <br />Sample Date <br />Collected By M T�',nr j l <br />Field Custodian ,%K+ <br />Delivered B <br />Received By <br />Date Recd. <br />Time Recd. <br />1. <br />2. <br />3. <br />5. <br />4 -ULLCI <br />VLL-019V LP M- l"YIIVa <br />2 -1 <br />9 aZ� <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotten: T <br />Al e <br />�'z C <br />_ a C "'. -0 0 <br />Sample Type: Air Water / Soi l Other (specify): <br />Analysis — Test series requested:. y,� ; / <br />Date analysis required by (if not Holding Time): _ <br />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 />) and explain below. <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />6,91B <br />Date <br />Page 8 of 8 <br />