Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal %:'� S U ?I <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No. Lab. No.(s) <br />Sample Date .. , �k - r-, Time- j <br />Collected By c --'t f ! 1 <br />Field Custodian '0�4-1 Pr <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />M <br />i� <br />3. <br />4. <br />5. <br />w� «r <br />LF W(UURL19a <br />(WRI'DiLt <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not Cotter- <br />C. <br />�. it a•�y;; i.��t Lid � i q Y t. �� R !'' <br />f <br />Sample Type: Air Water 4' Soil Other (specify): <br />Analysis - Test series requested: C f,., <br />~mar. -• e <br />Field Data - Preservation: ✓ . r -+•� (.: h L /•f t% .� �-- �-,, s d . <br />Date analysis required by (if not Holding Time): . <br />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 <br />Date <br />Page 9 of 10 <br />