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 615788842
Project Name: Schwartz -
DATE: 8111/11 SSTF: S25164
Report Mail Address:
Cotter Corporation - Canon City Mill
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: POTWNVWTP
Other
Water
C Number of Containers
ER — I Sample V O
X Air, Water Soils/Solids, Vegetation,
X Bioassay Qther
❑
�
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
a and scheduling
Rec ' t Temp
jc,_ _ 0° C
0
® TABLE 2 - Footnote "2" applies
•
01 TABLE 2 - Footnote "1" applies
❑
❑
•
❑
❑
•
•
Special Report Formats — ELI must be
to sample submittal for the foliov
NELAC ❑ A2LA ❑ Level
Other
EDD /EDT Format
O prior r c
•
01 RUSH Tumaround (1
Comments:
SBA Schedule Code :
GW CEDE:
la..
Table 2
Custody N al
Y /4''
Intact
Y/N
Signature
Y / N
Match I NB ID
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
9:55
FAN
8/11/11
0
0
0
0
0
0
0
0
•
0
•
•
•
0
•
0
0
0
0
•
•
0
0
0
❑
•
❑
❑
❑
•
❑
❑
❑
•
❑
•
❑
•
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•
•
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❑
❑
e
•
❑
❑
❑
❑
❑
■
❑
■
❑
❑
❑
•
-
0
0
0
0
0
0
1
.
0
0
0
8
❑
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
•
❑
❑
10
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:8 /12/11 14 30
Shipped by:
Received by: ate/Time:?"— V jC
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal
LABORATORY USE ONLY
Sam T # 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
61. 40 81. a6ed