2012-01-23_HYDROLOGY - M1977300 ‎(3)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/23/2012
• Doc Name: COTTER MONTHLY & QUARTERLY DATA, PART 1 OF THREE
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61588828
Project Name: Schwartz -
DATE: _8/9111 SSTF: S25152-- S25159
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215
Contact Name: Randy Whicker
Voice: 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
JoAnne Ary
1413 ext. 209
-1669
Purchase Order #:
ELI Quote #:
Report Required For: POTVI
Other
Number of Contains
Sample Type:
— AWSVBO
Air, Water Soils/Solids, Vegetation,
) C Bioassay Other
Normat Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
F additional charges
b and scheduling
Receiptemp
C
U - dissolved only - CODE #1
£# 3000 - P®Moss!P v l 3 - (1
Ra -226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
C�oler�D(s)
Special Report Formats — ELI must be
prior to sample submittal for the follor
NELAC ❑ A2LA ❑ Level
Other
EDD /EDT [] Format
Custody eal
Y /`
Intact CJ
Y / N
Signature
Y / N
Match LAB ID
Y / N
RUSH Turnaround
Comments:
SBA Schedule Code :
SW CODE 11
Table 1
Frequency 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
8/9/11
9:30
Water
■■
❑
❑
•
•
❑
•
❑
❑
❑
.-
❑
Code 1
2 SW A001
8/9111
10:20
Water
0
•
❑
❑
•
❑
❑
❑
❑
❑
0
•
Code 1
3 SW BDIS
8/9/11
10:30
Water
®
•
❑
❑
37
❑
❑
•
❑
•
0
•
Code 1
4 SW PL
8/9/11
10:35
Water
o
❑
•
•
•
❑
❑
❑
•
❑
❑
Code 1
5 SW OS
8/9/11
11:55
Water
❑
❑
•
•
•
❑
❑
•
❑
0
•
Code 1
6 SW BOS
8/9/11
12:00
Water
0
•
❑
•
❑
•
❑
❑
❑
❑
0
❑
Code 1
SW GS
8/9/11
12:05
Water
0
•
❑
❑
❑
❑
❑
❑
❑
❑
•
Code 1
e SW BPL
8/9/11
13:05
Water
0
•
❑
❑
❑
•
❑
❑
•
❑
0
❑
Code 1
9
M
❑
❑
❑
❑
❑
❑
•
❑
•
•
❑
10
❑
•
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
/ ' , OWr
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:8 /9/11 17:30
Sh pped by:
Sh pped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received by:x,„;,/, - . Date/Time: ga. it /2:3
Sample Disposal: Return to Client ❑ Lab Disposal e
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
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