2015-06-17_HYDROLOGY - M1977300 ‎(2)‎

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

0
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
11
Sample Submittal .: 21 S S
C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700
Cafion City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424
Sample Loc./ID No.
Sample Date 44 Time
Collected By
Field Custodian
Delivered By
Received By
Date Recd.
Time Recd.
I.VIICI"
7'
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination If not Cotter:
1. Sample Type: Air - Water Soil Other (specify):
2. Analysis - Test series requested:
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:
) Check if additional attachments.
QA Review:
Sample valid? YES NO
QAC
) and explain below.
) If NO, explain:
Date
Page 23 of 24
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination If not Cotter:
1. Sample Type: Air - Water Soil Other (specify):
2. Analysis - Test series requested:
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:
) Check if additional attachments.
QA Review:
Sample valid? YES NO
QAC
) and explain below.
) If NO, explain:
Date
Page 23 of 24