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. 4681 1228 3017
Project Name: Schwartz -
DATE: 8/19/11 SSTF: S25917
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
' 19- 275 -7413 ext. 209
Fax: [phone]
Purchase Order #:
ELI Quote #:
Report Required For: POIVVNVWTP
Other
f Number of Containers
Sample Type:
AWSVBO
Air, Water $ oiiis /Solids, Vegetation,
X Bioassay Qther
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
a and scheduling
Receipt Temp
/P. `'I ° C
III ..Z" aoutool - Z 31t3Vl.
TABLE 2 - Footnote "1" applies
Special Report
prior to sample
NELAC •
Other
EDD /EDT
Formats — ELI must be notified
submittal for the follow
A2LA 0 Level IV
0 Format
Cooler ID(s)
C l...&) I
RUSH Turnaround (1
1
Comments:
SBA Schedule Code :
GW CODE:
Fre uen :
Custody� al
Y ,is
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
Domestic Well
8/19/11
10:05
Water
0=
❑
•
❑
❑
•
0
•
❑
■ a
Table 2
❑
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•
•
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❑
❑
•
❑
❑
•
•
•
❑
D
•
❑
•
•
D
•
D
•
❑
°
❑
•
❑
■
❑
❑
❑
0
a
❑
D
D
5
•
0
•
•
0
1
0
•
0
1 3
0
•
B
•
0
0
0
0
•
0
0
•
0
•
0
0
0
•
0
•
0
0
•
0
0
■ ❑
8
0
0
0
•
0
0
0
0
•
•
•
❑
s
0
0
❑
❑
•
❑
•
❑
❑
•
❑
❑
10
•
❑
❑
❑
❑
❑
❑
❑
•
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:8 /19/11 14 30
Shipped byl % ji
Shipped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received by(,, I Date/Time:2t -&-1f y 0C
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
Sample Type # of fractions
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