2011-05-23_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/23/2011
• Doc Name: SW Data- April, 2011, SW 4/19/11 S25751-S25758
• 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 61 576047
Project Name: Schwartz -
DATE: _ 4/19/11 SSTF: S25751--S25758
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81;
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
Tel: [phone] ext. 209
Fax: 275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: PO
Other
g Number of Contains
D Sample Type:
—I AWSVBO
XI gir. Water acids/Solids, Vegetation,
XC Bioassay Other
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
R additional charges
g, and scheduling
Recei t T
ynj
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
SEE ATTACHES TABLE 1
o�lgr ID(�)
C l l L
��n
Special Report Formats — ELI mu;
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ L
Other
EDD /EDT ❑ Format
Custody Seal
Y /�
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
RUSH Turnaround i
Comments:
S&A Schedule Code :
SW CODE 11
Table 1
Frequency' 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
SW AWD
4/19/11
10:50
Water
e
•
❑
❑
•
❑
❑
❑
❑
•
®
❑
Code 1
SW A001
4/19/11
11:00
Water
❑
•
•
=4
•
❑
❑
❑
❑
•
=o
•
Table 1
SW BDIS
4/19/11
12:50
Water
.�
❑
•
•
•
❑
•
❑
❑
•
k:
❑
Code 1
SW PL
4/19/11
12:55
Water
0
•
❑
❑
❑
❑
❑
❑
•
❑
0
❑
Code 1
SW OS
4/19/11
13:05
Water
0
❑
❑
•
•
•
❑
❑
•
•
0
•
Code 1
e SW BOS
4/19/11
14:25
Water
0
❑
❑
•
•
❑
❑
❑
❑
•
='
❑
Code 1
SW GS
4/19/11
14:35
Water
■4
❑
•
•
•
❑
•
❑
❑
•
0
•
Code 1
e SW BPL
4/19/11
14:45
Water
0
•
❑
•
•
❑
❑
❑
•
❑
•
Code 1
9
•
0
0
•
0
•
0
0
0
0
•
10
❑
■
•
•
❑
❑
•
•
❑
❑
•
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:4 /19/11 17 00
Sh pped by:V'J C y
Receive b i Date/Time: /1
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal ►1�
LABORATORY USE ONLY
Sam • le T • e # of fractions
BEM 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
LASORA roR /Es