2011-01-12_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/12/2011
• Doc Name: November 2010 Surface Water Monitoring Data- 1.
• From: Cotter
• To: CDPHE- WQCD
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal ' , ,1_' S 25263
S
C: P.O. Box 1750 S: A.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Canon City, CO 81215 Nucla, CO 81424
Sample Loc./ID No. '17 lt/ 1n 0 S _ Lab. No.(s) ._
Sample Date I "d3 - 706) Time / /2 i?2 Date Data Entered
91 -
r?-?- G ' Data Entry By
Collected By
Field Custodian Laboratory Destination if not Cotter:
Delivered By
Received By
Date Reed.
Time Recd.
I. U LLCC 1/11-01W UCJL111UL1UL

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1. Sample Type: Air Water _, K Soil . Other (specify):
2. Analysis - Test series requested: 4?
3. Field Data - Preservation:
4. Date analysis required by (if not Holding Time): .
5. Special handling conditions or other instructions:
6. Invalidating circumstances? If YES initial
COMMENTS - Explanation of noted items:
( ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO( ) If NO, explain:
) and explain below.
QAC Date