2013-11-26_HYDROLOGY - M1977300 ‎(5)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 11/26/2013
• Doc Name: Water Data for September 2013 - 2
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal °,` ~ s2'7160
C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424
Sample Loc. /ID No. 5 Gtl /9 / "Z- Lab. No.(s)
Sample Date " /7- —Time-1 ;L 1
Collected By �..� �, �y..t .,► G
Field Custodian
Delivered By
Received By
Date Recd.
Time Recd.
Date Data Entered
Data Entry By
Laboratory Destination If not Cotter:
'T
1. Sample lope: Air Water,o� Soil Other (specify):
2. Analysis - Test series requested: ( 6 -A f
3.
1
� . S ,--< X
4. Date analysis required by (if not Holding Time): _
5. Special handling conditions or other instructions:
6. Invalidating circumstances? If YES initial
COMMENTS - Explanation of noted items:
( ) Check If additional attachments.
QA Review:
Sample valid? YES
QAC
) and explain below.
) NO( ) If NO, explain:
Date
Page 8 of 8
v11101M LocauRativu
g-ac� - 3
AF.' L�
Date Data Entered
Data Entry By
Laboratory Destination If not Cotter:
'T
1. Sample lope: Air Water,o� Soil Other (specify):
2. Analysis - Test series requested: ( 6 -A f
3.
1
� . S ,--< X
4. Date analysis required by (if not Holding Time): _
5. Special handling conditions or other instructions:
6. Invalidating circumstances? If YES initial
COMMENTS - Explanation of noted items:
( ) Check If additional attachments.
QA Review:
Sample valid? YES
QAC
) and explain below.
) NO( ) If NO, explain:
Date
Page 8 of 8