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. 4681 1228 2889
Project Name: Schwartz - ell
DATE: 9/23/11 SSTF: 526016- S26017
Report Mall Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -
Contact Name: Randy Whicker
V 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
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT ❑
For: POIVV/WVVTP
Other
notified
C Number of Containers
y Sam Type:
—1 AWSVBO
7) Air, Water Soils/Solids. yegetation,
X ¢ioassay Qther
Normal Turnaround (TAT) J
<
RUSH Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
and scheduling
Receipt Temp
C. to ° C
segdde "s" atoutood - z 3181/1
TABLE 2 - Footnote "1" appNes
Formats — ELI must be
submittal for the following:
A2LA ❑ Level
Format
Cooler ID(s)
GI( r)
Comments:
SBA Schedule Code :
GW CODE:
Fre uen :
Custody S aI
Y / IV
Intact
Y / N
Signature
Y / N
Match LAB ID
YIN
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
MW -9
9/22/11
13:15
Water
®
❑
❑
❑
❑
❑
❑
0
❑
•
•
•
SUMP -10
9/23/11
7 :50
Water
®
❑
❑
❑
❑
0
15 day turn around
•
•
•
•
•
❑
❑
❑
❑
❑
❑
❑
•
•
•
•
•
❑
❑
❑
❑
❑
❑
❑
•
•
•
.
•
❑
❑
❑
❑
❑
❑
•
•
•
•
•
•
6
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
•
•
0
0
0
0
0
0
0
0
0
0
0
•
❑
❑
❑
❑
❑
❑
❑
❑
.
.
•
•
9
❑
❑
❑
❑
❑
❑
❑
❑
•
•
•
.
10
❑
❑
❑
❑
❑
❑
❑
❑ 0
LI 1 01 0 9.56.
•
•
•
Custody
Record
MUST be
Signed
Relinquished
by: Bob Tqnnant
Date/Time:9
/23/11
10
30
Shipped
by:
Received
by: Date/Time:
Relinquished by: Date/Time:
Shipped by:
Received by:) Date/Time:
sSC 1.26.11 �� 1,
Sample Disposal: Return to Client ❑ Lab Disposal
LABORATORY USE ONLY
Sample Type # of fractions
CI
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
oz 8 abed