2016-01-26_GENERAL DOCUMENTS - M1977300

• Permit No: M1977300
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 1/26/2016
• 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 S 2$753
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc./ID No. Df .ty c'
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
Time // /
Lab. No.(s)
Date Data Entered
Collected By Data Entry By
Field Custodian 1 r Laboratory Destination if not Cotter:
Cotter Off Site Destination S ;.1 • •
Sample Date
Delivered By
Received By
Date Recd.
Time Recd.
1. Sample Type: Air
r,.
Water Soil
2. Analysis — Test series requested: % ' ' !`
7
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t tf
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Other (specify):
3. Field Data — Preservation: / ,(
,J!/ 7 l ,>
I
T"c._r 1/ 07 7,, c . ,?.
7
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 19 of 20
-
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:
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1. Sample Type: Air
r,.
Water Soil
2. Analysis — Test series requested: % ' ' !`
7
•
t tf
.^J
Other (specify):
3. Field Data — Preservation: / ,(
,J!/ 7 l ,>
I
T"c._r 1/ 07 7,, c . ,?.
7
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 19 of 20