2015-12-04_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/4/2015
• Doc Name: Water Quality/Mine Lever Measurements for Aug/Sept, 2015
• From: Cotter Corporation
• To: DRMS
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal !`i:.. S28359
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc./ID No. St.) Q 6S
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
Sample Date / - - /5 -
Time �`,• / '
Collected By 4 7?' p7,? c /-
Field
Field Custodian ' 7 4..44 fri 7`
Delivered By
Received By
Date Recd.
Time Recd.
Off S'•
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
y«.y.
y
1. Sample Type: Air Water / Soil Other (specify):
2. Analysis - Test series requested: C e'P /
3. Field Data - Preservation: r' • , // %. /o (, , / /7/L1
/ 1 ) L. f 46/Alc/,Z
/-)
H
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 29 of 31
1t.,U«VL -IM )VStlnalUU
/7).•4. r-
fe//J�E,,
q 13115
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
y«.y.
y
1. Sample Type: Air Water / Soil Other (specify):
2. Analysis - Test series requested: C e'P /
3. Field Data - Preservation: r' • , // %. /o (, , / /7/L1
/ 1 ) L. f 46/Alc/,Z
/-)
H
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 29 of 31