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. 5128 0900 1713
Project Name: Schwartz -
DATE: 4/27/12 SSTF: S26359
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -175
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
275 - 7413 ext 209
' 275 - 1669
Purchase Order #:
ELI Quote #:
ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify EU prior to
RUSH sample
submittal for
additional charges
6 and scheduling
Ft -
Receipt Temp
P. y -c
Report Required For. POTWANWTP
Other
III
ammo „z d - z nevi
TABLE 2 - Footnote "1" appfas
Special Report Formats C' ' must be notified
prior to sample su bmittal for the following:
NELAC 0 A Level IV 0
Other
EDD/EDT 0 Forrnat
Number of Contefnei
Samp. pe:
Sir. Mater Adis/Seeds, Xe
X Bioassay Ober
Cooler ID(s)
L 1,44
RUSH Tumaround (1
� i � LL
Custody = -
Y /MT
Intact
YIN
Signature
Y / N
Match LAB ID
Y / N
SAMPLE
IDENTIFICATION
(Name, Location,
interval, etc)
Collection
Time
'
❑
D
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•
D
•
D
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.
❑D
>;
z SUMP - 10
4/27/12
10:40
Water 6
®
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0
0
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0
_,
D
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Z
US
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D
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•
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•
D
•
•
D
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•
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6
•
•
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•
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•
•
•
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•
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CZ
a
❑
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•
•
a
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•
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I- bk 33
0
0
0
0
•
•
•
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•
ce
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0
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tie
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D
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D
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•
— 11
io
0
•
•
0
0
0
0
0
•
0
0
0
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennint Date/Time:4/27 /12 1830
Shipped by: FedEx _ _ _
Received by Date/Txne:
Relinquished by Date/Time:
Shipped by:
Received by:,e;. 1s Date/Time: ?rte./ yc 9�l
Sample Disposal: Retum 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