2010-11-23_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 11/23/2010
• Doc Name: September 2010 Surface Water Monitoring Data and 3rd Quarter Ground Water
• From: Cotter
• To: CDPHE/WQCD
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

Chain of Custody and Analytical Request Record
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 2 of 2
Company Name: Cotter Corporation Project Name: Schwartzwalder
Tracking No. 3692013 001793414 Water Monitoring Program
REF #/ DATE: 7/2312010
Report Mail Address: Contact Name: Kristy Usnick Sampler Name if other than Contact:
Canon City, Mill 1-719-275-7413 EX 213 Bob Tennant
PO Box 1750 81215-1750
Invoice Address: Invoice Contact & Phone Purchase Order* ELI Quote M
Canon City Mill Kristy Usnick 2563
P0. Box 1750 81215-1750 1-719-275-7413 EX 213
Report Required For. POTWNWUTP ? DW Notify ELI prior to RUSH sample R
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Other e F submittal for additional charges and •z.3
Special Report Formats -ELI must be notified prior to .. e i a a scheduling C
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SAMPLE IDENTIFICATION Collection Collection ;WJ> N 0 CO
(Name, Location, Interval, etc) Date Time o 0
X N L
MATRIX D M M
1 orange pipe 7/20110 8:10 water ? ? ? ? 1-LUF
7122/10 17:40 Water ? ? ? ? ? Species Name
3 shaft SW 7122110 17:40 water ? ? ? ? ? F- c- c Speces Name
4 ? ? ? ? ? Species Name
e ? ? ? 0 ? 1: 1- E Species Name
6 ? ? ? ? ? Species Name
i ? ? ? ? ? Species Name
6 ? ? ? ? 11
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9 Species Name
to ? ? ? ? ? C Species Name
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d Relinquished by: Bob Tennant Date/Time: 7/23/10-16:00 Ship ped by: Received by: Datefrime:
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Record MUST Relinquished by: Date/Time: Ship ped by: Received by: -7.7:f,, G c' ,I, Daterrime:
be Signed
Sample Disposal: Return to Client ?
Lab Disposal LABORATORY USE ONLY
Sample T rpe # of fractions
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In certain circumstances, samples submitted to Energy Laboratories, Inc. may be subcontracted to other certified laboratories in order to complete the analysis requested, This serves
as notice of this possibility. All sub-contract data
will be clearly notated on year nnal.?tical report.