2011-06-07_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 6/7/2011
• 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 61578478
Project Name: Schwartz - III
DATE: SSTF: S25836--S25833
_6/07111
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
275 -7413 ext. 209
Fax: - 275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: POTW/WVVTI
Other
s H
< i
j
MATRIX
a
b
b
(iV1) punaewnl ieWLON
Notify ELI prior to
RUSH sample
submittal for
a additional charges
t and scheduling
Re�� T p
/o C
.-
w
U - dissolved only - CODE #1
E
E# MOO -P PVfe1o1 - n
8
c#3a00 POMoSS!P'8 Ie1 9ZZ-B 4
,
SEE ATTACHED TABLE 1
ler ID(s)
��
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT ■Format
Formats — ELI must be notified
submittal for the following:
A2LA ❑ Level IV
■
Custody p9a I
Y /
Intact
YIN
Signature
Y / N
Match LAB ID
Y / N
RUSH Tumaround
Comments:
SB A Schedule Code :
SWCODEII
Table 1
Frequency' 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
6/07/11
9:00
Water
❑
❑
❑
®
•
•
•
❑
❑
❑
•
Table 1
2 SW AO01
6/07/11
9 :15
Water
®
•
❑
•
❑
❑
❑
•
❑
•
®
•
Code 1
3 SW BDIS
6/07/11
10:55
Water
®
❑
❑
•
•
❑
❑
❑
❑
•
-°
❑
Code 1
Water
I@
❑
❑
•
•
❑
❑
❑
❑
•
n
❑
Code 1
4 SW PL
6/07/11
11:00
5 SW os
6/07/11
11:10
Water
®
❑
•
•
❑
•
•
❑
❑
•
•
Code 1
6 SW BOS
6/07/11
12:30
Water
®
•
❑
•
•
❑
❑
•
•
•
-o
•
Code 1
Water
o
•
❑
❑
❑
to
❑
❑
•
•
=o
•
Code 1
' SW GS
6/07/11
14:35
s SW BPL
6/07/11
13:35
Water
•
❑
❑
®
❑
•
❑
❑
❑
❑
o-
❑
I Table 1
y :
9
•
•
❑
•
•
•
•
•
•
in
•
•
10
0 0
0
•
•
0
•
0 0
•
•
❑
Custody
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:6 /07/11 16:30
Shipped by:
.7
Shipped by: 0 cfL�/
Received b : Date/Time:
Re5eh12 R Date/Timel 1
Relinquished by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal i.:1
LABORATORY USE O NLY
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