2011-09-12_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/12/2011
• Doc Name: SWQ Monitoring Results- July 2011- Part 1
• From: Cotter
• To: CDPHE-WQCD and DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61578729
Project Name: Schwartz -
DATE: SSTF: S25884 - -- S25886
_7/13/11
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
Report Mail Address:
Cotter Corporation - Canon City
PO Box 1750; Canon City, CO
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Invoice Contact: JoAnne Ary
9- 275 -7413 ext. 209
Fax: [phone]
Purchase Order #:
ELI Quote #:
Report Required For:
Other
C Number of Contains
y Sample Type:
—I AWSVBO
Xi Air, Water aoilsISolids, Vegetation,
)C bioassay Other
r
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
R additional charges
. and scheduling
Receipt Temp
lc. o C
C ler ID(s)
U .. dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
I
SEE ATTACHED TABLE 1
Special Report
prior to sample
NELAC •
Other
EDD /EDT
Formats — ELI must be notified
submittal for the
A2LA ❑
❑ Format
Cust y eal
Intac
Y / N
Signature
Y / N
Match LAB ID
Y / N
RUSH Tumaround i
Comments:
S&A Schedule Code :
SW CODE 13
Table 1
Frequency/ 4,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW FBRG
7/13/11
10:10
Water
❑
❑
❑
•
•
•
❑
•
❑
®
❑
Table 1
2 SW ARH
7/13/11
12:50
Water
❑
•o
®
•
•
•
❑
❑
•
•
®
❑
Code 3
3 SW LLHG
7/13/11
13:05
Water
■
Z
®
❑
■
❑
■
❑
■
❑
::
0
I
Code 3
4
•
•
❑
•
•
❑
•
❑
•
•
•
❑
5
❑
•
❑
•
•
•
❑
❑
•
❑
❑
❑
6
❑
❑
•
❑
❑
❑
•
❑
❑
•
❑
❑
•
❑
❑
•
•
❑
❑
❑
•
❑
❑
❑
$
❑
•
❑
❑
•
•
0
0
O
•
❑
❑
9
❑
•
•
❑
❑
❑
❑
❑
•
•
❑
❑
Nok ..5z
10
•
❑
❑
•
❑
■
❑
■
❑
•
❑
.
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:7 /13/11 17 30
Sh pped by: •
Received by:. Date/Time: 7..pi_ I C f~
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
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