2016-01-04_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/4/2016
• Doc Name: Water Quality Data/Mine Level Measurements
• From: Cotter Corp
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal NE S 2 S 4 41
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc./ID No.fL-
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
Sample Date / 0. 2 - # S Time / 3 i
Collected By I�C < Ti�Nr ► r
Field Custodian ae T/'+t i G ^
Delivered By
Received By
Date Recd.
Time Recd.
Of S'rteDestat'
nIo«er f
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
1. Sample Type: Air Water ire.. Soil Other (specify):
2. Analysis — Test series requested: / 4 4 /
3. Field Data — Preservation: fee / d. 3 r, /77,4 7 _'; J 6/ E U y cf �
4,4 r C. 0. Z L �� ,tir-), -r
/G- 1// /,
O.Z5cui-, 4-.iLuf:/1 L Sl.,
(1. S-L.elf Aye /1 2 f •
z
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
Page 14 of 1Q
-tnio
/3C 4
/
n�,.,0I*
1
1015 Its01-,55
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
1. Sample Type: Air Water ire.. Soil Other (specify):
2. Analysis — Test series requested: / 4 4 /
3. Field Data — Preservation: fee / d. 3 r, /77,4 7 _'; J 6/ E U y cf �
4,4 r C. 0. Z L �� ,tir-), -r
/G- 1// /,
O.Z5cui-, 4-.iLuf:/1 L Sl.,
(1. S-L.elf Aye /1 2 f •
z
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
Page 14 of 1Q