2011-07-01_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 7/1/2011
• Doc Name: May 2011 SW Quality Data- SW 5/25/11 S25798-S25800.
• From: ENERGY Labs and Cotter Corp.
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61578423
Project Name: Schwartz -
DATE: 5/25/11 SSTF: 525798 - -- S25800
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 812
Contact Name: Randy Whicker
1 -719- 275 -7413 ext. 210
Sampler Name if other than Contact;
1- 303 -642 -3893 mine phone
Bob Tennant 1- 719 - 371 - 3009 -cell
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Invoice Contact: JoAnne Ary
5 -7413 ext. 209
Fax: 75 - 1669
Purchase Order #:
ELI Quote #:
_
Report Required For: PO
Other
Number of Contains
Sample Type:
-� AWSVBO
Air, water Soils/Solids, Vegetation,
X Bioassay Other
(ivi) punorewni leuIoN
1
Notify ELI prior to
RUSH sample
submittal for
R additional charges
. and scheduling
Re�eipt,Temp
/ , C
U - dissolved only - CODE #1
£S 300o - penloss!p V 1%01 - n
Ra-226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
ler ID(s)
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT •
Formats — ELI must
submittal for the following:
A2LA • LE
Format
Custody a l
Y f
'�
Intact
Y / N
Signature
Y / N
Match LAB ID
YI
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODES 3
Table 1
Frequency/ 4,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW FBRG
5/25/11
9:15
Water
•
0
®
❑
❑
■
•
■
■
•
®
■
Code 3
2 SW ARH
5/25/11
9:30
Water
•
❑
❑
ci
❑
•
•
❑
❑
•
CO
•
Table 1
3 SW LLHG
5/25/11
9:45
Water
•
®
®
•
•
❑
•
•
•
•
❑
Code 3
4
•
•
•
•
•
❑
•
•
•
•
•
❑
5
•
•
•
•
•
•
❑
❑
❑
❑
•
❑
8
❑
•
❑
•
❑
•
❑
•
•
❑
•
p
eilasql
7
0
0
0
0
•
•
0
0
•
0
•
0
8
❑
•
•
❑
•
❑
❑
❑
•
❑
❑
❑
g
•
•
•
0
0
•
0
••
•
•
❑
10
•
•
❑
❑
❑
•
•
❑
❑
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:5 /25/11 16 30
Shipped by:
Received by: Date/Time: 5 26
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time:
Sample Disposal: Return to Client • Lab Disposal ®
LABORATORY USE ONLY
Sample Type # of fractions ,
Chain of Custody and Analytical Request Record
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1