2012-01-23_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/23/2012
• Doc Name: Cotter Monthly and Quarterly Data, Part 2 of 3
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61588798
Project Name: Schwartz -
DATE: _812/11 SSTF: S25901-- S25908
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215
Contact N - -- Randy Whicker
- 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
JoAnne Ary
'413 ext. 209
Fax: - 1669
Purchase Order #:
ELI Quote #:
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
6 additional charges
t ✓ and scheduling
Receipt T mp
� 5 o C
/3'. q
Report Required For: POTW
Other
U - dissolved only - CODE *1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
Cooler ID(s)
G oo �n
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT •
Formats — ELI must be
submittal for the follorn
A2LA III Level
Format
Number of Con ne
Sample Type:
AWSVBO
Air, Water aals/Solids, Yew
X Iiijoassay Q
Cutody al
s
Y /(
Intact
Y / N
Signature
Y / N
Match LAB ID
YIN
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE $1
Table 1
Frequency 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
SW AWD
8/2/11
10:45
Water
❑
•
❑
0
❑
•
•
•
•
❑
0
•
Table 1
z SW A001
8/2/11
11:00
Water
c ∎
❑
❑
•
•
❑
❑
•
0
❑
.:
❑
Code 1
SW BDIS
8/2/11
12:35
Water
0
❑
❑
•
❑
❑
•
❑
•
•
0
❑
Code 1
SW PL
8/2/11
12:40
Water
❑
❑
❑
❑
•
❑
❑
•
•
0
❑
Code 1
SW OS
8/2/11
12:45
Water
0
❑
•
❑
•
❑
❑
•
❑
❑
■-
❑
Code 1
SW BOS
8/2/11
13:40
Water
0
❑
•
❑
❑
❑
•
•
❑
❑
®
❑
Code 1
SW GS
8/2/11
13:45
Water
0
❑
•
•
❑
❑
•
❑
❑
❑
®
❑
Code 1
SW BPL
8/2/11
14:45
Water
•
❑
❑
w
❑
❑
❑
•
❑
❑
c
❑
Table 1
s
❑
•
❑
❑
❑
❑
❑
❑
0
❑
❑
❑
10
❑
❑
❑
❑
•
❑
❑
❑
•
•
e}}pgo I5
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:8 /2/11 17:30
Sh pped by:
Sh pped by:
Received by: Date/Time:
R elinquished by: Date/Time:
Re ceived by ate/Time: g3-1/ 0:5
Sample Disposal: Return to Client ❑ Lab Disposal ig
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
1.17 ze abed