2012-01-23_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/23/2012
• Doc Name: Cotter Monthly and Quarterly Data Part 1 of 3.
• From: Cotter Corp.
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. _3692013 615788811
Project Name: Schwab - III
DATE: 8/4/11 SSTF: S25873
Report Mail Address:
Cotter Corporation - Canon City Milt
PO Box 1750; Canon City, CO 81215
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
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Invoice Contact: JoAnne Ary
719 - 275 -7413 ext. 209
Fax: - 719 - 275 - 1669
Purchase Order #:
ELI Quote #:
Report Required For: POTWNVVVTP
Other
E Number of Containers
D Sample Type:
-I AWSV130
Air, Water $oils/Solids, Vegetation,
X Bioassa other
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
a and scheduling
Receipt Temp
° C
TABLE 2 - Footnote "2" applies 1
TABLE 2 - Footnote "t" applies
Special Report Formats — ELI must be
prior to sample submittal for the following:
NELAC ❑ A2LA • Level
Other
EDD /EDT ❑ Format
Cooler ID(s)
RUSH Turnaround (T
Comments:
S&A Schedule Code :
GW CODE:
F r e , :
Custody Seal
Y / N
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 MW - 00
8/4/11
9:55
Water
❑
❑
•
•
•
❑
❑
❑
❑
ci
❑
Table 2
2 MW - 0
8/5/11
10:35
water
..
•
❑
❑
❑
❑
❑
•
❑
❑
®
•
Table 2
3
1
❑
❑
.
.
❑
❑
■
■
❑
•
1
4
❑
❑
•
❑
❑
•
❑
❑
❑
•
❑
•
b
❑
❑
•
❑
❑
❑
❑
•
❑
❑
❑
•
6
❑
•
❑
❑
❑
❑
❑
❑
❑
•
❑
❑
7
❑
•
1
•
❑
.
.
❑
.
❑
❑
❑
8
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
•
❑
9
0
•
.
0
0
0
•
❑
■
❑
1
.
❑
' CAO t ?Sp
10
❑
❑
❑
❑
❑
•
•
❑
❑
•
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time :8 /5111 14:30
Shipped by:
Shipped by:
Received by: Date/Time:
Received by,L,... Date/Time: g g. it /pa)
Relinquished by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal 21
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
CZ Jo OZ abed