2012-01-23_HYDROLOGY - M1977300 ‎(3)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/23/2012
• Doc Name: COTTER MONTHLY & QUARTERLY DATA, PART 1 OF THREE
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal i ? S rinn!
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc. /ID No. 5 13 Pi Lab. No.(s)
Sample Date E> " 7 Time
Collected By � / f , -.- - e -
Field Custodian r' 7 C 1 -
Delivered By
Received By
Date Recd.
Time Recd.
1. Sample Type: Air
2. Analysis — Test series requested: ' ✓�
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
1
3. Field Data — Preservation: / b • 0
, r , , 2 . 1 .
.9
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
e r •
t
i
l
• r
G /
• t.
R,/
Water 1 Soil Other (specify):
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:
QAC Date
t Lu u
l -VLLCC
Vll-OI J1 LLL7161uu
f' .
, ,.r
/ . - .-
COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal i ? S rinn!
C: P.O. Box 1750
Canon City, CO 81215
Sample Loc. /ID No. 5 13 Pi Lab. No.(s)
Sample Date E> " 7 Time
Collected By � / f , -.- - e -
Field Custodian r' 7 C 1 -
Delivered By
Received By
Date Recd.
Time Recd.
1. Sample Type: Air
2. Analysis — Test series requested: ' ✓�
S: P.O. Box 1750 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
1
3. Field Data — Preservation: / b • 0
, r , , 2 . 1 .
.9
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
e r •
t
i
l
• r
G /
• t.
R,/
Water 1 Soil Other (specify):
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:
QAC Date
t Lu u