2016-09-13_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/13/2016
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal_ S # b
C: P.O. Box 1756 S: P.O.Box 1750 N: P.O. Box 700
Cafion City, CO 81215 Canon City, CO 81215 Nucia, CO 81424
f
Sample Loc./ID No. ,. ,y, Gam; i Lab. No.(s)
Sample Date .� ,r. Time �/ !5� Date Data Entered
Collected By Data Entry By
Field Custodian Laboratory Destination if not Cotter:
Cotter Off-Site Destination 17
Delivered By }S 4 2
Received BY
Date Recd.
Time Recd. W S Z
I. Sample Type: Air Water Soil Other (specify):
2. Analysis — Test series requested:__ t
3. Field Data—Preservation:
�► 7
4. Date analysis required by (if not Holding Time):
S. 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 f ) If NO, explain:
QAC Date
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