2011-05-31_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/31/2011
• Doc Name: 2nd Qtr. 2011 GW Monitoring Data- 4-28-11.
• 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 61576078
Project Name: Schwartz - '
DATE: _ 4128/11 SSTF: 525724 & 25725
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81
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
I: 1- 719 - 275 -7413 ext. 209
c: 1 719 - 275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: PC
Other
Number of Containers
Sample Type:
AWSV80
Air, water So0wsolws, v_e .
ebassay Ohm
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
F additional charges
a and scheduling
Receipt Telly, e
$. ]-
sla! ..z., mota00A - z 319vt
soisdde.i.moutoo4-z mow.
Special Report
prior to sample
NELAC •
Other
EDDIEDT
Formats – ELI must be notified
submittal for the following:
A2LA ❑ Level IV 0
0 Format
C I r ID(
RUSH Turnaround (1
Comments:
SBA Schedule Code :
GW CODE:
F u
CustodOeol
Y CNI
Intact
Y / N
Signature
Y / N
Match LAB ID
Y/N
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
MW -2
4/27/11
11:00
Water
®
•
❑
•
•
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®
•
Table 2
s Domestic Well
4/28/11
9:55
Water
®
❑
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•
•
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•
❑
.:
•
Table 2
a
2
.
•
•
0 0
0
0
0
0
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Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:4 /29/11 13 30
Shipped by: X"
Received by A . s - e/Time: / /I /7);
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time:
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