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 2748
Project Name: Schwartz - IIIII
DATE: 12/29/11 SSTF: S26170 — 526171
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215-1750
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]X
Purchase Order #:
ELI Quote #:
r
Report Required For: PO1W/WWIP 0
Other
I Number of Containers
If Sample Type:
-i AWSVBO
x Air, Water §oils/Solids, x►.
ilioessaY Otter
(1111) punaJewni IewwN
Notify ELI prior to
RUSH sample
submittal for
additional charges
< and scheduling
Receipt Temp
( . G ° C 1
{ SON ..Z,. end - Z 318V1
solldde .1. 0 - Z slew.
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level i1 0
Other
DD /EDT Format
Cooler ID(s)
0. to
V Puncuewnl HS(1H
Comments:
S&A Schedule Code :
GW CODE:
Fro uen :
Custody S al
Y
Intact 1
Y / N
Signature
Y / N
Match LAB ID
Y / N
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
M W - 6
12/29/11
10:10
W a t e r 6
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Custody
MUST be
MUST
Si 9 ned
Relinquished by: Bob Tennant Date/Time:12 /29/11
Shipped by: FedEx
Received by: Date/Time:
16:00
Relinquished b : Date/Time:
Y
Shi ed b :
Shipped by:
Received b � .G:fte_ DatelTime: � -3a1
yl� / / /c :
Sample Disposal: Return to Client • Lab Disposal ®
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