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 .: °_ 5 263 8 7
C: P.O. Box 1750
Callon City, CO 81215
Sample Loc./ID No.W ,4 Lt1 0
Sample Date 'S - /5" -- /./ 2 Time /3 3 s
Collected By R. 7/ G'f t
Field Custodian J.7,) I0 ir+ c
Delivered By
Received By
Date Recd.
Time Recd
•
1. Sample Type: Air Water [,c Soil Other (specify):
2. Analysis - Test series requested: t G P /
3. Field Data - Preservation: r /2 . 6 �,/-7 7 V 6 - Cr, � (J 2 6 2. !
r e n Z,�2 , . ,_.. z „ /-7,
5 L /`'A6/4/0 7. s --1
S: P.O. Box 1750 N: P.O. Box 700
Cation City, CO 81215 Nncla, CO 81424
Lab. No.(s)
Date Data Entered
Data Entry By
Laboratory Destination if not Cotter:
�
/9 P v'5 t,/ G 4 /, s� G it j r •• S ! 1 C.
� .S Cr S, /t re. e e k # 41/
s e , Gv y. g 6, , r
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
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