2016-10-24_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 10/24/2016
• Doc Name: Water Level Monitoring
• From: Cotter Corporation
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal 2 V f!
C: P.O. Box 1750 S: P.O.Box 1750
Canon City, CO 81215 Cation City, CO 81215 N' Nuc Boa 700
ucla, CO 81424
Sample Loc./ID No. A&./ /) 1) Lab.No.(s)
Sample Date Timef 5 Date Data Entered
Collected By
Data Entry By �
Field Custodian1' 1 7. rr�: Laboratory Destination if not Cotter:
Cotter Oft-Site Destination,,
Delivered By
Received By
Date Recd.
Time Recd. i 30j
f Z
1. Sample Type: Air Water
3 Soil Other (specify):
2. Analysis— Test series requested: Y
3. Field Data—Preservation:
T t f I I
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: �r
Sample valid? YES ( ) NO ( ) If NO,explain:
QAC Date
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