Laserfiche WebLink
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal !:2 S <br />C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700 <br />Cation City, CO 81215 Caiion City, CO 81215 Nucla, CO 81424 <br />Sample Loc./ID No., i! W - I % Lab. No.(s) <br />Sample Date & J SThne _ Date Data Entered <br />Collected By . a Z r/! ..c., Data Entry By <br />Field Custodian -r, o Laboratory Destination if not Cotter: <br />Cotter Off-Site Destination e - - �- <br />Delivered By <br />Received By 2 Ir .!' '-1 I/L `r'. r `j I <br />Date Recd. t— J <br />Time Recd. 3� <br />1. Sample Type: Air Water '? // Soil Other (specify): <br />2. Analysis - Test series requested: <br />3. Field Data - Preservation: t <br />IL <br />4. Date analysis required by (if not Holding Time): <br />S. Special handling conditions or other instructions: <br />6. Invalidating circumstances? If YES initial ( ) and explain below. <br />COMMENTS - Explanation of noted items: <br />( ) Ch k if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( ) If NO, explain: <br />QAC <br />Date <br />— Page 22 of 23 <br />