2012-08-06_HYDROLOGY - M1977300 ‎(3)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/6/2012
• Doc Name: SURFACE WATER DATA FOR MAY 2012
• 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 .2 s26366
C: P.O. Box 1750 S:
Canon City, CO 81215
Sample Loc./ID No. S' Ct.) i '3 4' 6-
Sample Date Time / D ' / 0
Collected By /.. .; S te' n .+ r_ .41
Field Custodian 13,?
Delivered By
Received By
Date Recd.
Time Recd.
1.
2.
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Sample Type: Air Water 3 Soil Other (specify):
Analysis — Test series requested: (•7
QAC
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( ) Check if additional attachments.
QA Review:
Sample valid? YES ( ) NO (
P.O. Box 1150 N: P.O. Box 700
Canon City, CO 81215 Nucla, CO 81424
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
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3. Field Data — Preservation: r ° 8 r ? 7. S s , + S �o L. S.., '�
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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:
) If NO, explain:
Date
rage 29 of 30