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

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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM
Sample Submittal I :2 S 25161
C: P.O. Box 1750 S: P.O. Box 1750
Canon City, CO 81215 �o /� Carton City, CO 81215
Sample Loc./ID No. SCI) F 1 Il (r' Lab. No.(s)
Sample Date S ' /CO' 20// Time 1 S —
Collected By A 8
Field Custodian &. 4 7-Pit/,rd ".7�
Delivered By
Received By
Date Recd.
Time Recd.
Oft Sit n t• t•
3. Field Data - Preservation
',$e Pe �. 6 y j S s
2 L u /_/A /-//V D /v .
( ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO (
QAC
Soil
1. Sample Type: Air Water /
2. Analysis - Test series requested: ('v cA 2
6. Invalidating circumstances? If YES initial (
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
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Other (specify):
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4. Date analysis required by (if not Holding Time):
5. Special handling conditions or other instructions:
) and explain below.
COMMENTS - Explanation of noted items:
) If NO, explain:
Date
N: P.O. Box 700
Nucla, CO 81424
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