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 SZ
C: P.O. Box 1750 S: P.O. Box 1750
Cafion City, CO t8?1215 } j Callon City, CO 81215
Sample Loc./ID No. .3J L Lab. No.(s)
Sample Date Time J j,
Collected By
Field Custodian
Delivered By
Received *--
Date Recd.
Time Recd.
4vuc• VIL`OILC ALML11INUOa

'f JF
lf
/.,/ fI

1. Sample Type: Air Water
2. Analysis - Test series requested:
N: P.O. Box 700
Nucla, CO 81424
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
Soil Other (specify):
ot..
3. Field Data - Preservation: tJ t "1 `; .41 : % .
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.
COMMENTS - Explanation of noted items:
( ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO ( ) If NO, explain:
QAC
Date
e Page 33 of 38