Laserfiche WebLink
a COTTER C' OM 3PATION 3111 $ <br />Sample Submittal <br />C: P.O. IWX 1750 S: P.O. Box 1150- N: Fro. BoX <br />fi r, CO $1215 Canon City, CO 81215 °t <br />Sample Loc./ID No. w Ce <br />Sample Date Time `� • * 'r . ,! <br />Collected BI d b 71'r f <br />Field Costs" A .9 <br />Delivered By <br />Received By <br />Date 1RWA. <br />Time Recd. <br />a <br />Vll -AILC LeBiAlaLlOa <br />�Ahqk r2 <br />Date-Data <br />Data "iry lry <br />Laboratory Desamotion if not Cotter: <br />R 1 <br />00 AP <br />1. Sample lIype: Air Water _ Soil Other (specify): <br />2. Analysis — Test series requested: r Q , Te, <br />3. Field Data — Preservation: %- /1 _ r. - <br />Date analysis regoired -*y (H anOWeYding Time): <br />S. Special, ft -0 sss or other instructions: <br />6. Invalidating circumstances? It YES initial ( ) aask�_#��. <br />COMMENTS — Esplanathm of noted items: T AW <br />x <br />r. <br />( ) {^^Check if additional attachments. <br />QA Reviec.. <br />Sample valid? YES ( ) NO { ) If NO, explain: f <br />QAC Date <br />...cam <br />Page 6 of 6 <br />