2011-07-28_HYDROLOGY - M1977300 (2)

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Company Name: Cotter Corporation Tracking No. _3692013 61578485 Project Name: Schwartz - DATE: _618/11 SSTF: 525836 Report Mall Address: Cotter Corporation - Canon City Mill PO Box 1750; Canon City, CO E 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 Invoice Address: PO Box 1750 Canon City, CO 81215 -1750 Invoice Contact: JoAnne Ary 'el: 1 719 - 275 - 7413 ext. 209 'ax: 1 719 - 275 -1669 Purchase Order #: ELI Quote #: Report Required For: Porwmwrp 0 Other Number of Containers Sample Type: AWSVBO Air, Water Sods/Solids. Vegetation, > c Bioassay Qther Normal Turnaround (TAT) Notify ELI prior to RUSH sample submittal for additional charges rc and scheduling Rec tZ �rr+, V TABLE 2 - Footnote "2" applies TABLE 2 - Footnote "1" applies Special Report prior to sample NELAC • Other EDD /EDT Formats — ELI must submittal for the A2LA • Level IV ❑ Format CC I RUSH Tumaround (l Comments: S&A Schedule Code : GW CODE: Fr i uen CustodyaI Y 1 Intact Y / N Signature Y / N Match LAB ID Y / N SAMPLE IDENTIFICATION (Name, Location, Interval, etc) Collection Date Collection Time SOMP - -9 6/8/11 12:15 Water ® ❑ ❑ ❑ • ❑ ❑ 0 • . - ❑ Table 2 Z • 0 0 0 0 • 0 0 0 0 0 o 0 0 o 0 0 0 • 0 • 0 0 0 ° ❑ ❑ O ❑ ❑ ❑ ■ ❑ ■ • D • ■❑ O❑ O❑■ D O❑ O■ s 0 0 0 0 • 0 0 0 • 0 • • ❑ ❑ • ■ ❑ ❑ D D O ■ O . e 0 0 0 • • 0 0 0 0 0 • • D D D ■ ❑ . ❑ e D . . . ot `f 10 • 0 0 0 0 0 • 0 • • • • Custody Record MUST be Signed Relinquished by: Bob Tennant Date/Time:6 /8/11 15:30 Shipped by: Shipped by: �.�,� �, Received by: Date/Time: Relinquished by: Date/Time: Received by: ( Date/Time: � //4f 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