2015-06-17_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 6/17/2015
• Doc Name: Water Quality Data and Mine Level Measurements for March 2015
• From: Cotter Corporation
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal'
C• P O Box 1750
• 5: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424
Sample Loc./ID No. lw / ` Lab. No.(s)
Sample Date lime Date Data Entered
Collected By Data Entry By
Field Custodian Laboratory Destination if not Cotter:
CotterOff-Site Destination L
Delivered By
Received By 1
Date Recd. 2
Time Recd. -.
1. Sample Type: Air Water
2. Analysis — Test series requested:
Soil Other (specify):
3. Field Data — Preservation:
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:
) and explain below.
( ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO ) If NO, explain:
QAC
Date
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