2015-01-28_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: Hydrology
• Doc Date: 1/28/2015
• Doc Name: Water Quality Data and Mine Level Measurements for November 2014
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal
C: P.O.Boa 1750 S: P.O.Bog 1750 N: P.O.Boa 700
Canon City, CO 81215 Canon City, CO 81215 Nucla,CO 81424
Sample Loc./ID No. S�f t/ Z )41- Lab. No.(s)
Sample Date Time Date Data Entered
Collected By l ,a,�r s► r Data Entry By
Field Custodian le, �r Nn c. f Laboratory Destination K not Cotter:
Cotter Off-Site Destination
Delivered By
Received By ,.o
Date Recd.
Time Recd. - {
1. Sample Type: Air Water Soil Other(specify):
2. Analysis- Test series requested: T' '
3. Field Data-Preservation:
1
4. Date analysis required by(if not Holding Time):
S. 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