2013-03-14_HYDROLOGY - M1977300 (2)

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COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM Sample Submittal S 16717 S: P.O. Box 1750 N: P.O. Box 700 Canon City, CO 81215 Nucla, CO 81424 C: P.O. Box 1750 Canon City, CO 81215 Sample Loc. /ID No. —r Collected By •'5 ;) - Delivered By Received By Date Recd. Time Recd. Sample Date/ 7 (' /2 Time / 3 9 <> Field Custodian • .1 r: ( 3. Field Data — Preservation: , / l s n r ' 1 1 / , f7 l,4 1. Sample Type: Air Water 2. Analysis — Test series requested: ' 4. Date analysis required by (if not Holding Time): 5. Special handling conditions or other instructions: Lab. No.(s) Date Data Entered Data Entry By Laboratory Destination if not Cotter: • Soil Other (specify): l :2f/ f� 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 Page 7 of 7 1 .• COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM Sample Submittal S 16717 S: P.O. Box 1750 N: P.O. Box 700 Canon City, CO 81215 Nucla, CO 81424 C: P.O. Box 1750 Canon City, CO 81215 Sample Loc. /ID No. —r Collected By •'5 ;) - Delivered By Received By Date Recd. Time Recd. Sample Date/ 7 (' /2 Time / 3 9 <> Field Custodian • .1 r: ( 3. Field Data — Preservation: , / l s n r ' 1 1 / , f7 l,4 1. Sample Type: Air Water 2. Analysis — Test series requested: ' 4. Date analysis required by (if not Holding Time): 5. Special handling conditions or other instructions: Lab. No.(s) Date Data Entered Data Entry By Laboratory Destination if not Cotter: • Soil Other (specify): l :2f/ f� 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 Page 7 of 7