2012-02-22_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 2/22/2012
• Doc Name: SURFACE & GROUNDWATER DATA FOR FOURTH QTR 2011, PART 1 OF 2
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 4681 1230 2760
Project Name: Schwartz -
DATE: 12/20/11 SSTF: S26201
w
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1'
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
9- 275 -7413 ext. 209
Fax: [phone]
Purchase Order #:
ELI Quote It
_rX
Report Required For: POTWM
Other
f Number of Containers
Sample Type:
-� AWSVBO
A3 Air, I s. Vegetation,
x Flioassey Qther
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
< and scheduling
—F
Receipt Temp
o2_ it ° C
..Z.. egneod - Z 3181/1
Sell ..1.. 0 - Z 318V1
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level IV El
Other
EDD /EDT ❑ Format
Coole�r ID(s)
G /+'en 4
1) Punwewnl HSfla
Comments:
SBA Schedule Code :
GWCODE:
F :
re uenc
Custody aI
Y /6
Intact
Y/N
Signature
Y 1 N
Match LAB ID
YIN
SAMPLE
IDENTIFICATION
(Name, Location,
I nterval, etc)
Collection
Date
Collection
Time
1 SUMP -4
12J20/11
13:15
Water 6
0
❑
•
•
❑
•
❑
•
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
■
❑..
0
`
2
3
_
❑
❑
❑
❑
•
❑
❑
❑
❑
❑
❑
•
_
::C I1PCM
❑
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
❑
5
❑
•
❑
❑
•
•
•
❑
❑
❑
❑
❑
5
❑
•
❑
❑
•
❑
❑
❑
❑
O
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
•
5
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
9
❑
0
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
10
❑
❑
0
❑
❑
❑
❑
❑
•
❑
❑
•
Cu stody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:12/21 /11
Sh pped by: FedEx
Received by: Date/Time:
16:00
by: Date/Time:
Relinquished aeme:
b :
Shipped y
Received b : Date/Time:
Y ICt:�3st !off lQ'
Sample Disposal: Return to Client • Lab Disposal ®
Sample � RATORY USE of fractions
s
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