2011-06-15_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 6/15/2011
• Doc Name: June 2011 SW Data
• From: Energy Labs
• To: Cotter and DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 6157815
Project Name: Schwartz -
DATE: _6/15/11 SSTF: 52 - -- S25774
Contact Name: Randy Whicker
Voice: 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
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Invoice Contact: JoAnne Ary
Tel: 1 ext. 209
- 275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: POTWNVWTI
Other
1 g
� a °•
3 y
g a
z i
$
MATRIX
a
Notify ELI prior to
RUSH sample
submittal for
s= additional charges
t and scheduling
Rec Ipt T m
�„a
w
U - dissolved only - CODE #1
2
o
£# 3000 - PeAlos P V ie o1- n
Q
£#3400 PallossIP V 1433 9ZZ- I
SEE ATTACHED TABLE 1
Col r ID(s)
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA 0 Level IV ❑
Other
EDD /EDT ❑ Format
Custqqy Seal
((��(( /N
Intact
Y I N
Signature
Y ! N
Match LAB ID
Y / N
Normal Tumaroun
RUSH Tumaround
Comments:
S&A Schedule Code :
SW CODE 13
Table 1
Frequ 4,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
SW FRG L ,�,
6/14/11
11:00
Water
❑
®
0
❑
❑
•
❑
❑
❑
❑
•
Code 3
x SW ARH z 4n c
6/15/11
8:25
Water
0
0
0
•
❑
•
❑
•
❑
•
0 ❑
Code 3
SW LLHG
6/15/11
8:40
Water
❑
❑
•
0
❑
❑
•
•
❑
❑
0 ❑
Table 1
0
0
0
0
•
•
0
0
0
•
•
•
❑
❑
❑
•
•
❑
•
❑
❑
0
6
❑
❑
■
❑
❑
■
•
❑
•
•
❑ ❑
❑
❑
❑
•
❑
❑
❑
❑
❑
❑
❑ •
0
1 : 1
0
E
❑
•
❑
•
■
•
❑
0
❑
0
■
•
❑
0 •
0 0
CA ta.
e
•
•
■
Custody
Record
MUST be Signed
Relinquished by: Bob Tennant Date/Time:6 /15/11 12 30
Sh pped by: Received by: Date/Time: /C / /d%
Ship by ��� Received by: Date/Time:
lei(
b Date/Time:
Sample Disposal: Return to Client • Lab Disposal
r 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
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