2012-08-06_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/6/2012
• Doc Name: GROUNDWATER DATA FOR SECOND QUARTER 2012
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 5088 8525 4869
Project Name: Schwartz - -
DATE: 4/24/12 SSTF: S26350
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
1 9- 275 -7413 ext. 209
Fax: 19 275 - 1669
Purchase Order #:
ELI Quote #:
PE- hoc
Report Required For: POTWNVWTP
Other
Number of Containers
Sample Type:
—1 AWSVBO
Air, a Water Solids, yegetatbn,
X �i
ANALN - sv , Ietoutsi i
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
a and scheduling
Receipt Temp
Y . $ o c
solldele "Z" eloulood - Z 318Y1
TABLE 2 - Footnote "1" applies
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level IV
Other
EDD /EDT ❑ Format
Cooler ID(s)
C110
RUSH Turnaround (1
Comments:
S&A Schedule Code :
GW CODE:
Fre uen :
Custody l
Y / 6
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1
0
0
0
.
.
0
0
0
.
D
•
•
2 Mw - 9
4/24/12
10:10
Water 6
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•
-.4
"=„
3
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•
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•
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•
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1141
4
0
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•
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•
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•
O
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0 0O
5
•
0
•
•
•
0
0
•
0
0
•
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•
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D
1— C i 01194,
•
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9
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0
ca
9
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10
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Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant DatelTime:4/25/12 16 30
Sh
pped by: FedEx
Received by: DateTme:
Relinquished by Date/Time:
Sh'pped by:
Received by:Kg i v n Date/Time: y - .7t.) p q 34.r
Sample Disposal: Retum to Client ❑ Lab Disposal 0
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