2010-12-28_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/28/2010
• Doc Name: Nov. 2010 DMR
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal -, x 2 5 2 8 6
C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Cafion City, CO 81215 Nucla, CO 81424
Sample Loc./ID No. Lab. No.(s)
Sample Date I --?y' me ?? Date Data Entered
Collected By G !4:' r •" G J Data Entry By
?:; / ??,•,??• Laboratory Destination if not Cotter:
Field Custodian
Delivered By
Received B
Date Recd.
Time Recd.
I.VLLCi llll'O1LC L?J aluA4lVu

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