2012-02-22_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 2/22/2012
• Doc Name: SURFACE & GROUNDWATER DATA FOR FOURTH QTR 2011, PART 1 OF 2
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal S 26201
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc./ID No. _cf .t yp - 9
Sample Date 1 _ `" Time 13 /47 Time Data Entered
Collected By r._<_,04 �` a n c
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
Lab. No.(s)
Data Entry By
Field Custodian /Sit- ' ,n c ,� f Laboratory Destination if not Cotter:
Delivered By
Received By
Date Recd.
Time Recd.
Off S
3. Field Data - Preservation: - r - ' S y 7/ ? 'f l 7
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1. Sample Type: Air Water Soil Other (specify):
2. Analysis - Test series requested: ‘, ) e
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QAC Date
36
Page 19 of 19
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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:
Sample valid? YES ( ) NO ( ) If NO, explain: