2011-05-09_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/9/2011
• Doc Name: SW Data- April 2011, SW 4/06/11 S25692-S25699
• From: ENERGY Labs
• To: Cotter & DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61575996
Project Name: Schwartz -
DATE: 4106!11 SSTF: 525692--- S25699
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 8'
Contact Name: Randy Whicker
1 -719- 275 -7413 ext. 21C
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
275 - 7413 ext. 209
Fax: -275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: P�
Other
Number of Contains
Sample Type:
AWSVBO
Air, Water Soils/Solids, yepetabon,
X Bioassay Ober
Notify ELI prior to
RUSH sample
submittal for
F additional charges
a and scheduling
Receipt Temp
5•M{ 1t99 C
U - dissolved only - CODE #1
£# 3400 - pallon!P V [WI - fl
Ra-226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
Cooler
Special Report Formats — ELI must be notified
prior to sample submittal for the 1
NELAC ❑ A2LA ❑ Level IV
Other
EDD /EDT ❑ Format
•
Custody Seal
Y / 0
Intact
Y I N
Signature
Y / N
Match LAB ID
Y/N
Normal Tumaroun
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE 11
Table 1
Frequency 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
4/08/11
9:35
Water
❑
•
❑
0
•
❑
•
❑
❑
•
0 ❑
Table 1
2 SW A001
4/08/11
9:55
Water
®
•
❑
❑
❑
❑
❑
•
•
•
0 ❑
Code 1
SW BDIS
4/06/11
12:10
Water
0
•
❑
•
■
❑
❑
❑
❑
❑
0 •
Code 1
SW PL
4/08/11
12:20
Water
0
❑
❑
❑
❑
❑
❑
•
•
•
® ❑
Code 1
5 SW OS
4/08/11
12:30
Water
0
❑
❑
❑
❑
•
❑
■
❑
•
0 ❑
Code 1
e SW BOS
4/06 /11
12:40
Water
0
❑
❑
❑
•
•
■
❑
•
•
0 •
Code 1
SW GS
4/06/11
14:20
Water
0
❑
❑
•
•
❑
❑
❑
❑
❑
0 •
Code 1
8 SW BPL
4106/11
14:30
Water
•
❑
❑
0
•
❑
❑
•
❑
•
0 •
Table 1
g
■
■
■
■
■
■
❑
■
■
■
❑ ■■
l't �Ll`tV C .` t I
10
❑
❑
❑
❑
❑
•
•
•
❑
•
• •
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant DatelTime:4 /06111 16.30
Sh pped by: Race e y: Date/Time: %-k."1 .1\
Shipped by: Received by: Date/Time: tticro
Relinquished by: Date/Time:
LABORATORY USE ONLY
Sample Disposal: Return to Client ❑ Lab Disposal ® 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
Et Jo 17£ abed