2011-03-03_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/3/2011
• Doc Name: Jan. 2011 SW Data- Pt. 1
• 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 S 25 427
C: P.O. Box 1750 S: P.O. Box 1750 N: P.O. Box 700
Cason City, CO 81215 Canon City, CO 81215 Nucla, CO 81424
Sample LocAD No. S t A 0 5 Lab. No.(s)
Sample Date Time /57: SO
Collected By '.96 b
Field Custodian 4?0 4 -
Delivered By
Received By
Date Recd.
Time Recd.
1.
2.

O :O ?-
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
rA- n
w-
k1 z 64 ?-
t v?
-,.?
/a C''
Sample Type: Air Water ?? Soil Other (specify):
Analysis - Test series requested: n
3. Field Data - Preservation:

o?
a`' 0, 5" L "

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:
QAC
Date
Page 17 of 20
) and explain below.