2014-01-14_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/14/2014
• Doc Name: Surface water data and mine level measurements for November, 2013
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal _, t S272st
S: P.O. Box 1750 N: P.O. Box 700
C: P.O. Box 1750
Cafion City, COf 81215 Cafion City, CO 81215 Nucla, CO 81424
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Sample LocJID No. i Lab. No.(s)
Sample Date 1 - '� Time
Collected By _
Field Custodian
Delivered By F �
Received By
Date Recd.
1 00? -r
Time Recd. 3
1.
2.
3.
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
r� !
4t <.ft ..f/
Sample Type: Air Water Soil Other (specify):
Analysis - Test series requested:
Data - Preservation:
4. Date analysis required by (if not Holding Time):
5. Special handling conditions or other instructions:
6. Invalidating circumstances? If YES initial ( ) and explain below.
COMMENTS - Explanation of noted items:
{ ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO ( ) If NO, explain:
QAC Date